Congenital - Trachea
Reoperation to correct unsuccessful vascular ring and vascular decompression surgeryAlthough most children do well after operations to relieve vascular compression of the esophagus and airway, many will have persistent/recurrent symptoms. We review our surgical experience using a customized approach to correct various etiologies of failure after vascular ring/decompression surgery.
Tracheal surgery for airway anomalies associated with increased mortality in pediatric patients undergoing heart surgery: Society of Thoracic Surgeons Database analysisAirway anomalies are common in children with cardiac disease but with an unquantified impact on outcomes. We sought to define the association between airway anomalies and tracheal surgery with cardiac surgery outcomes using the Society of Thoracic Surgery Congenital Heart Surgery Database.
Commentary: Malacia got you down? Unwind with a helical stentSevere cases of pediatric tracheobronchomalacia can require tracheostomy, prolonged periods of positive pressure ventilation, and/or invasive surgical procedures intended to stabilize the airways. Prior attempts at therapeutic internal airway stenting to avoid the need for positive pressure ventilation in children have been largely unsuccessful due to poor mucous clearance, fragmentation, and diameter reduction. Surgical approaches are invasive and carry a significant failure rate along with risks of fistulization and other complications.
Commentary: Toward a more ideal pediatric airway stent for tracheobronchomalaciaThe first clinical deployment of a pediatric airway stent was in 1988 and was reported by Loeff and colleagues.2 Since that time, an array of airway stents have developed to treat complex airway disease in children. Pediatric-specific applications of airway stents include use after tracheal reconstruction for congenital tracheal stenosis3 and for tracheobronchomalacia4 not responsive to medical therapy. However, the ideal pediatric airway stent has yet to be developed. The ideal airway stent for pediatric patients should be easy to place, should support the airway without the development of significant complications, and should be easy to remove to allow maximal growth of the airway.
Preclinical evaluation of a pediatric airway stent for tracheobronchomalaciaWe sought to demonstrate in an animal model that helical stents made from a nickel titanium alloy called nitinol (NiTi) and designed for malacic airways could be delivered and removed without significant trauma while minimally impeding mucus clearance during the period of implantation.
Commentary: Three-dimensional printing: Reshaping opportunities in congenital cardiac surgeryIn the current issue of the Journal, Wang and colleagues1 from China report their successful management of severe bronchomalacia of the left main bronchus in a 9-year-old girl who presented with wheezing and recurrent pulmonary infections. After failure of endoluminal stenting approaches, the patient underwent left posterolateral thoracotomy and placement of a custom-made 3-dimensional (3D) printed (3DP) polycaprolactone scaffold to suspend the outside of that bronchus on the inner surface of the scaffold.
Treatment of bronchomalacia using three-dimensional printed polycaprolactone scaffold in a pediatric patientBronchomalacia, a weakness of the bronchus due to the reduction and/or atrophy of the longitudinal elastic fibers or impaired cartilage integrity, is a rare respiratory disease in children. Green and colleagues1,2 first used a 3-dimensional printed (3DP) polycaprolactone (PCL) scaffold to suspend the malacic bronchus and achieved excellent therapeutic results. However, few cases have been reported on the application of this technology or the clinical features of scaffold in vivo. Herein, a pediatric patient with left mainstem bronchomalacia was cured using the 3DP PCL scaffold technique.