先天性気管狭窄症／先天性声門下狭窄症

PURPOSE: In patients with a left pulmonary artery sling (LPAS) and congenital tracheal stenosis, indications for simultaneous slide tracheoplasty remain controversial. This study quantified three-dimensional tracheal morphologic changes after LPAS repair with and without slide tracheoplasty to provide insights into establishing surgical indications. METHODS: Airway geometries were reconstructed from pre- and postoperative computed tomography scans in 13 patients (10 with tracheoplasty, three with LPAS repair alone), measuring equivalent diameter and geometry-based flow resistance in a 30-mm segment proximal to the carina. All results are expressed as median [range]. RESULTS: The tracheoplasty group showed significant pericarinal enlargement (3.3 [2.4-4.1] to 5.2 [4.2-6.7] mm; P = 0.002) and a marked decrease in resistance estimates (2.30 [0.83-9.6] to 0.39 [0.11-1.88] cmH2O/(L/s); P = 0.004). In the LPAS repair alone group, two patients exhibited low preoperative resistance estimates (0.92 and 1.52 cmH2O/(L/s)), comparable to postoperative values in the tracheoplasty group. CONCLUSION: Slide tracheoplasty provides substantial morphologic and functional improvements, but certain patients achieve acceptable airway resistance with LPAS repair alone. Computational flow resistance may represent a useful tool for visualizing or quantifying the effects of surgical intervention.

OBJECTIVE: To investigate associations of intraoperative autologous blood salvage (IOCS) combined with allogeneic transfusion vs. allogeneic transfusion alone in pediatric slide tracheoplasty (STP) for congenital tracheal stenosis (CTS), regarding hematological parameters, coagulation function, clinical outcomes, and safety. METHODS: From October 2023 to February 2025, 69 children meeting inclusion criteria were enrolled in this non-randomized study. Based on parental consent for IOCS, 35 were allocated to the observation group (IOCS + allogeneic transfusion) and 34 to the control group (allogeneic transfusion alone). Pre- and postoperative hematological and coagulation parameters, allogeneic transfusion volume, adverse reactions, postoperative fever, hospital stay, and 6-month mortality were compared. RESULTS: Preoperative indicators showed no significant intergroup differences (P > 0.05). Postoperatively, the observation group had higher red blood cell count, hematocrit, and hemoglobin (all P < 0.05); shorter prothrombin time and higher fibrinogen (both P < 0.05); and no significant differences in APTT or TT (both P > 0.05). Intraoperative allogeneic red blood cell and fresh frozen plasma volumes were significantly lower in the observation group (both P < 0.05). No hemolytic or allergic transfusion reactions occurred. Postoperative fever was higher in the control group (P < 0.05), and hospital stay was shorter in the observation group (P < 0.05). No deaths occurred within 6 months. CONCLUSION: IOCS combined with allogeneic transfusion was associated with better postoperative hematological and coagulation profiles, reduced allogeneic blood requirements, and shorter hospital stay. No transfusion-related adverse reactions or deaths were observed. These findings warrant confirmation in prospective randomized studies.

BACKGROUND: Few studies have focused on the respiratory management after slide tracheoplasty. This study aimed to evaluate the effect of high-flow nasal cannula (HFNC) compared with conventional therapy in preventing reintubation after slide tracheoplasty. METHODS: This was a retrospective study conducted at a single center, the Department of Pediatric Surgery. The medical records of 68 patients who had undergone slide tracheoplasty for congenital tracheal stenosis (CTS) before the age of 2 years from February 2012 to September 2021 were included. Patients were divided into group C (conventional therapy) or H (HFNC therapy), based on whether conventional oxygen therapy and positive pressure ventilation or HFNC was used after withdrawal from the ventilator, respectively. RESULTS: There were no significant differences in the postoperative reintubation rate and ventilator dependency between groups C and H. There were no HFNC complications. CONCLUSIONS: The use of postoperative HFNC is not inferior to noninvasive ventilation in terms of therapeutic efficacy. HFNC can be used without complications for a limited time after extubation.

OBJECTIVE: The study objective was to investigate the anatomic and clinical factors associated with tracheoplasty in children with pulmonary artery sling and congenital tracheal stenosis. METHODS: This retrospective multicenter study included children with pulmonary artery sling who underwent surgical treatment at 3 cardiac centers in China between January 2010 and September 2025. Preoperative clinical characteristics, computed tomography measurements, and operative data were reviewed. Univariable and multivariable logistic regression analyses were performed to identify factors independently associated with tracheoplasty. Interaction analyses were also conducted. RESULTS: After excluding 24 patients with incomplete preoperative imaging data, 330 patients with pulmonary artery sling and congenital tracheal stenosis were included. Among them, 302 (91.5%) underwent slide tracheoplasty and 28 (8.5%) underwent pulmonary artery sling correction alone. Younger age, long-segment tracheal stenosis, and more severe airway narrowing were independently associated with a higher frequency of tracheoplasty. CONCLUSIONS: Younger age, long-segment tracheal stenosis, and more severe airway narrowing were independently associated with tracheoplasty in this multicenter cohort. Tracheoplasty performance appeared to be influenced by multiple factors rather than any single imaging parameter. Further prospective studies with long-term follow-up are required to evaluate clinical outcomes associated with different management strategies.

We report the case of a child with right pulmonary agenesis, congenital tracheal stenosis, and atrial septal defect (ASD). At age 2 years, an intrathoracic tissue expander was placed to reduce tracheal compression from mediastinal shift and to enable subsequent atrial septal defect closure. At age 5 years, a right atrial mass was incidentally detected along with right atrial compression caused by the expander. Emergency mass resection was performed, and the mass was diagnosed as a thrombus. The tissue expander was subsequently deflated and removed to prevent further compression. The patient had no recurrence of thrombus or respiratory symptoms during 8-year follow-up.