Congenital Problems of the Trachea
Significant advances have been made in the care of infants and children with congenital tracheal stenosis over the past 50 years. Innovations in preoperative diagnostic techniques and surgical strategies have improved the long-term outcomes for this patient population. In this chapter we have reviewed the symptoms, diagnostic techniques, operative strategies, outcomes and complications, and future directions for these patients.
Tracheal stenosis in children is primarily caused by congenital complete cartilage tracheal rings. These infants present with severe respiratory distress early in life. The highlights of the historical surgical events include the first tracheal resection (1958), cartilage tracheoplasty (1981), pericardial tracheoplasty (1982), slide tracheoplasty (1989), homograft tracheoplasty (1994), and tracheal autograft (1996). Successful tracheal surgery centers are using cardiopulmonary bypass, simultaneous repair of associated pulmonary artery sling and cardiac anomalies, and the current procedure of choice—slide tracheoplasty.
The outlook for these children is currently quite good, and successful outcomes are particularly evident at institutions with a careful multidisciplinary approach to these patients.
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