REPAIR OF A LARYNGOTRACHEOESOPHAGEAL CLEFT IN AN INFANT BY MEANS OF EXTRACORPOREAL MEMBRANE-OXYGENATION

Few survivors have been reported following attempted repair of laryngo tracheoesophageal clefts (LTECs). The major challenge is maintaining o xygenation, both during the surgical repair and during the postoperati ve period of healing. We report a neonate with an LTEC extending to th e carina whose successful repair was facilitated by extracorporeal mem brane oxygenation (ECMO) begun intraoperatively and continued postoper atively for 11 days. The intraoperative surgical exposure of the defec t was excellent. Postoperative trauma to the fresh tracheal repair fro m ventilatory pressures and endotracheal tube motion was eliminated th rough the use of ECMO. The patient was discharged without a tracheotom y and with a normal voice, cry, and swallow. According to this result, the use of ECMO may represent a significant advance in facilitating t he correction of major laryngotracheoesophageal anomalies. The rationa le, advantages, disadvantages, and potential pitfalls of this approach are presented, as well as preoperative and postoperative documentatio n of our results.