EXPERIENCE IN TRACHEOBRONCHIAL RECONSTRUCTION WITH A COSTAL CARTILAGEGRAFT FOR CONGENITAL TRACHEAL STENOSIS

Although successful surgical management of congenital tracheal stenosi s has been reported, it is still controversial as to the best operativ e procedure. Eleven infants with congenital tracheal stenosis were eva luated to confirm the efficacy of tracheobronchial reconstruction with costal cartilage graft, Symptoms ranged from recurrent respiratory in fection to severe respiratory failure. All infants had other congenita l anomalies in addition to tracheal stenosis. Notably five infants had pulmonary artery sling and four infants had patent ductus arteriosus. Definitive diagnosis was made by bronchoscopy, results of which showe d complete tracheal rings in all patients with severely compromised tr acheobronchial lumens. Five infants had elongated stenosis involving n early the whole length of the trachea, and five infants had segmental stenosis involving nearly one half the length of the trachea, One infa nt had bilateral stenosis of the main bronchi. Early experience includ ed two deaths from problems related to the repair. The involvement of the carina and the distal portion of the trachea was associated with i ncreased complications and a higher mortality rate. Currently our pref erred technique facilitated by extracorporeal membrane oxygenation (EC MO) includes carinal reconstruction with a thin-wall intraluminal sten t. Bronchoscopy is essential for accurate intraoperative incision of t he trachea, postoperative airway management for several weeks, and rem oval of the intraluminal stent. Copyright (C) 1997 by W.B. Saunders Co mpany