USE OF CARBON-DIOXIDE BRONCHOLASER FOR AC QUIRED TRACHEOBRONCHIAL STENOSES IN CHILDREN WITH BRONCHOPULMONARY DYSPLASIA

Objective. - Evaluation of carbon dioxide (CO2) broncholaser for treat ing acquired proximal tracheo-bronchial stenosis in children with bron chopulmonary dysplasia. Design. - Retrospective study from June 1987 t hrough August 1995, with 39 months follow-up. Patients and methods. - During the study, 65 children were treated for bronchopulmonary dyspla sia. Eight of those (average age: 42.6 months) had symptomatic tracheo -bronchial stenosis; they were treated with CO2 broncholaser and repre sented 23.5% of all broncholaser applications. All patients presented multiple lesions. Ten symptomatic well-organized lesions (obstructive bridles or diaphragms), all accessible to broncholaser, were treated. Broncholaser was the primary treatment used, except in one case where it was used following balloon dilatation failure. An adaptable rigid f ibroscope combined with a CO2 Sharplan laser was used. All interventio ns were performed under general anesthesia. Results. - Lesions not rea ching the trachea's bifurcation (eight cases) disappeared following on e laser session with significant clinical improvement. Lesions extendi ng to the trachea's bifurcation (two cases) only showed partial improv ement despite three laser sessions. The results remained stable throug hout the follow-up period There were no major complications. Conclusio ns. - Broncholaser is a safe and efficient method of treating stenoses occurring in patients with bronchopulmonary dysplasias. Obstructive l esions (such as bridles or diaphragms) and those which do not reach th e trachea's bifurcation, give the best results.