Necrotizing tracheobronchitis in patent ductus arteriosus-dependent cyanotic congenital heart disease

We report 2 patients with necrotizing tracheobronchitis (NTB) associated wi th patent ductus arteriosus-dependent cyanotic congenital heart disease. Th e pathologic findings suggest that hypotension and decreased tracheo-bronch ial perfusion were the major contributing factors in the development of NTS . Necrotizing tracheobronchits developed in infants with pulmonary atresia and Ebstein's anomaly with pulmonary stenosis. Both infants required prosta glandin El infusion from early infancy, and presented with sudden onset of dyspnea and hypercapnea. In one infant, NTB developed prior to mechanical v entilation. In the other infant, NTB developed after 4 days of mechanical v entilation. Care of both infants involved minimal pressures and FiO(2), ade quate humidification, and optimal temperature of inspired gases; these fact ors probably did not play a role in the development or worsening of NTB. Bo th infants had hypotension and hypoxemia. These factors could have contribu ted to the development of NTB because of decreased perfusion pressure and t issue hypoxia. As the area of necrosis and its severity correlated with the area of blood supply served by the specific feeding arteries, we speculate that tissue hypoperfusion was the major cause of NTB, (C) 2001 Wiley-Liss, Inc.