Murzi Bruno, Arcieri Luigi, Moschetti Riccardo,Cantinotti Massimiliano, Assanta Nadia, Chiappa Enrico, Pozzi Marco ,

Paola Serio , Baggi Roberto, Mirabile Lorenzo

“G. Monasterio” Tuscan Foundation , “G. Pasquinucci” Heart Hospital

TRACHEO-BRONCHIAL ANOMALIES: A WIDE SPECTRUM OF DISEASE REQUIRING A MULTIDISCIPLINARY APPROACH BY A CONSTITUTION OF A TRACHEAL TEAM

Bari 12-15 Ottobre 2011

XLI Congresso Nazionale della Società Italiana della Cardiologia Pediatrica e Sezione Pediatrica Società Italiana di Chirurgia Cardiaca

Tracheo-Bronchial Surgical Activity (2007-2011)

67 Patients

u15 Tracheoplasty

u52 Surgical Airways decompression

Tracheoplasty

15 Patientsu11 Slide Tracheoplasty

u2 Resection and End to End (Double Aortic Arch)

u1 Patch Tracheoplasty

u1 Cleft type IV correction

Tracheoplasty

15 PatientsuMean age 11 (1-84) months

uAssociated cardiac anomalies

u 1 Aortic Insufficiency

u 1 ToF

u 1 DIV

u 2 Pulmonary Artery Sling

u 1 PA + DIV

Tracheoplasty

11 Slide Tracheoplastyu2 Bronchus Suis

u1 Left Lung Agenesia

u1 Single stage Correction of ToF + CTS● Bronchus Suis, 3Kg, premature

u8 CTS length > 50%

Tracheoplasty

Tracheoplasty

CLEFT TYPE IV

CLEFT TYPE IV

CLEFT TYPE IV

CLEFT TYPE IV

CLEFT TYPE IV

CLEFT TYPE IV

Tracheoplasty1 Patch Tracheoplasty

Tracheoplasty1 Patch Tracheoplasty

Tracheoplasty

RESULTSu1 Early Death

u Left Lung Agenesia, 20 days ECMO

uNo Major Complications

uAll but 3 extubated on 5th post operative day

u4 Stent Inserted, all Removed

Airway compression Ø 52 cases of surgical relief of airways compression - January 2007 -- July

2011.Ø Mean age 32,1 ± 40 months (range 1,8 month-15 years);

Ø mean weight 8,7 kg (range 2,9-20 kg)

Ø In 11 patients a tracheal stent was implanted before surgery

Airway compression

Airway compression

Previous Procedures

Cardiac Surgery

2 Int Arc Ao (LBCDA)1 Truncus (LBCDA)2 DKS (LBCDA)1 cTGA , PM (IAC)1 PDA (IAC)2 ToF (ARSA , IAC)1 VSD (ARSA)

General Surgery 21 T/E fistula or EA

9 IAC2 BT2 ARSA8 LBCDA

Surgical Approach

According to the anatomy different surgical approaches were chosen:

T inverted mini-sternotomy ( 22 pt)

Left thoracotomy (27 pt)

Right thoractomy (3 pt)

Fare clic per modificare stili del testo dello schemaSecondo livello

● Terzo livello● Quarto livello

● Quinto livello

Airway compression

Bicarotic Trunk

Mini Sternotomy: Anterior Aortopexy for BT

LBCDACompression (left main bronchus) anteriorly and superiorly by left pulmonary artery and posteriorly by descending thoracic aorta

Thoracotomy

HEADDescending

Thoracic Aorta

LBCDA

8 DAA

2 tracheoplastiche ( intubazione )

1 sezione arco + stent

4 aortopessi anteriori successivamente a sezione arco dx

1 sezione arco dx

Follow-up and results Ø No major intra-operative complication.

Ø The median follow-up is of 26,5 ± 20,5 months.

Ø Symptoms were abolished in all but 4 .

Ø 4 Re-operation for symptomatic residual compression at short term follow-up ( LBCDA)

Ø Stents were removed in 6 (30%) of 20 patients where implanted

CONSIDERATIONS

Tracheal anomalies reflect a wide spectrum of pathology

Tracheal surgical treatment is just a part of the need of care for these patients Hybrid and multidisciplinary approach are mandatory

Tracheal Team