ANOMALIES OF THE TRACHEOBRONCHIAL TREE IN PATIENTS WITH ESOPHAGEAL ATRESIA

To examine associated anatomic anomalies of the tracheobronchial tree and structural abnormalities of the trachea, and their clinical conseq uences, bronchoscopic examination and follow-up studies were performed in 32 patients with esophageal atresia (EA) and tracheoesophageal fis tula (TEF) over a 5-year period. To evaluate structural abnormalities of trachea, the ratio of circumferential length of cartilaginous trach ea to circumferential length of membranous trachea (C:M ratio) was det ermined before surgical repair. In patients examined before and after surgical repair, the motion of the posterior tracheal wall was observe d under spontaneous respiration. Fifteen of the 32 patients (47%) had abnormalities of the tracheobronchial tree such as ectopic right upper bronchus (12), congenital bronchial stenosis (4), and absence of the right upper bronchus (2). The C:M ratio of the 27 patients with EA (2. 0 +/- 0.6) was significantly lower than that of controls (3.0 +/- 0.3) ; the ratio for the 10 cases with ectopic right upper bronchus (1.7 +/ - 0.4) was significantly lower than that of other cases (2.2 +/- 0.5). The C:M ratio for the 12 patients who had atelectasis (1.7 +/- 0.3) w as significantly lower than that of the 15 who did not have atelectasi s (2.2 +/- 0.6). Of 24 infants, nine had bulging of the posterior trac heal wall synchronized with expiration, and their C:M ratio (1.8 +/- 0 .2) was significantly lower than that of the 15 patients without bulgi ng (2.2 +/- 0.6). These data show an association between anatomic anom alies of the tracheobronchial tree and structural abnormalities of the trachea in patients with EA. Because these abnormalities may be relat ed to the occurrence of respiratory disorders such as tracheomalacia a nd atelectasis, early bronchoscopic examination, including measurement of the C:M ratio and observation of the motion of the posterior trach eal wall under spontaneous respiration, may be useful in the care of p atients with EA. Copyright (C) 1996 by W.B. Saunders Company