Congenital - Trachea
Commentary: Malacia got you down? Unwind with a helical stent
Severe 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 tracheobronchomalacia
The 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.Commentary: Three-dimensional printing: Reshaping opportunities in congenital cardiac surgery
In 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.
