AIRWAY COMPRESSION IN CHILDREN DUE TO CONGENITAL HEART-DISEASE - VALUE OF FLEXIBLE FIBEROPTIC BRONCHOSCOPIC ASSESSMENT

Objective:To evaluate the frequency and severity of airway compression due to congenital heart disease in children and validate the use of t he fiberoptic bronchoscope to assess them. Design: A retrospective stu dy. Setting: A single-institutional study in a university hospital. Pa rticipants: Seventy-two children with congenital heart disease. Interv entions: Airway endoscopy was performed in an awake child in cases of clinical and/or radiologic respiratory signs or in cases of preoperati ve assessment of a cardiac abnormality that is known to accompany airw ay compression. Measurements and Main Results: Endoscopy was well tole rated; 71% of the children had endoscopic abnormalities and 50% had ai rway compression. The locations of these compressions are the same as those described in the literature in the cases of vascular rings and l eft-to-right shunts. The other endoscopic findings were laryngeal and bronchial abnormalities, tracheobronchial malacia, respiratory signs o f gastroesophageal reflux, and positive bacteriologic sputum samples. Conclusion: Endoscopy in an awake patient is the only way to evaluate the functional component of a compression due to malacia; the resultin g collapse of the airway can cause trapping of air and secretions. Fur thermore, fiberoptic bronchoscopy offers a complete examination of the airways and can help detect airway abnormalities that are potential c auses of complications. Fiberoptic bronchoscopy is a suitable and well -tolerated examination that is easy to perform at the bedside of the c hild. This technique optimizes the preoperative assessment of children with congenital heart disease. Copyright (C) 1998 by W.B. Saunders Co mpany.