Cases reported "Tracheal Stenosis"

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1/99. A bronchogenic cyst in an infant causing tracheal occlusion and cardiac arrest.

    A 3-month-old infant treated for 3 weeks for suspected bronchiolitis, developed episodes of profound desaturation. A lateral X-ray showed displacement and compression of the trachea. Respiratory arrest, from which she was successfully resuscitated, occurred just before MRI scan. The mass was removed at thoracotomy and a histological diagnosis of a bronchogenic cyst was made. Mediastinal masses in babies are relatively rare, and the situation in which they present with acute respiratory distress may prove extremely challenging to the anaesthetist. Bronchogenic cysts are difficult to diagnose pre-operatively and awareness may assist in the peri-operative management of these infants.
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ranking = 1
keywords = operative
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2/99. Anterior mediastinal masses: an anaesthetic challenge.

    A patient with a large anterior mediastinal mass with minimal respiratory symptoms presented for a diagnostic biopsy of the mass. A pre-operative thoracic computed tomographic scan demonstrated narrowing of the distal trachea, and right and left main stem bronchi. An awake intubation was done. Thiopentone and muscle relaxant were given and surgery commenced. High airway pressure developed and ventilation became difficult, although oxygenation remained satisfactory throughout. Anaesthetic implications are discussed. We recommend that patients with more than 50% obstruction of the airway at the level of the lower trachea and main bronchi have their femoral vessels cannulated in readiness for cardiopulmonary bypass.
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ranking = 0.5
keywords = operative
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3/99. Long-segment congenital tracheal stenosis: treatment by slide-tracheoplasty.

    BACKGROUND/PURPOSE: The prognosis of long-segment funnel-shaped congenital tracheal stenosis improved with surgical management by enlargement-tracheoplasty with a pericardial patch. However, the final outcome is not always satisfying mainly because of the complications related to the pericardial graft and because of misdiagnosed associated cardiovascular malformations. The objective of the report is to show a further improvement of the prognosis by a thorough preoperative planning and the use of a slide-tracheoplasty for the cure of the stenosis, to avoid the major drawbacks of enlargement tracheoplasties. methods: Two children, 7 months and 3 years old, underwent a bronchoesophagoscopy, spiral computed tomography, an echocardiogram, and a heart catheterization. The tracheal stenosis and the associated severe cardiovascular malformations were cured during a single operative session under cardiopulmonary bypass; the tracheal stenosis was corrected by a slide-tracheoplasty. RESULTS: The postoperative period was remarkably uneventful and the recovery extremely quick (hospital stay of 18 and 17 days). The midterm results are excellent, and the tracheal growth is not impaired (follow-up of 3 1/2 and 3 years). CONCLUSIONS: According to the authors' experience and to the literature, the slide-tracheoplasty seems to be the most efficient surgical procedure for correction of long-segment funnel-shaped congenital tracheal stenosis. But the success of the treatment depends also on a complete preoperative diagnosis allowing a 1-stage surgical treatment of all associated thoracic malformations.
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ranking = 2
keywords = operative
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4/99. Intraoperative use of automated external defibrillator.

    We report on the anesthetic management of a patient with peripartum cardiomyopathy and frequent episodes of ventricular tachycardia, who underwent surgery for tracheal stenosis. Prior to this surgery, the patient had been implanted with an automatic implantable cardioverter-defibrillator (AICD), placed abdominally. In the operating room, the AICD was deactivated, and an automated external defibrillator (AED) was placed. Intraoperatively, the AED identified and treated the patient's ventricular tachycardia. Advantages of the AED in this hospital setting included rapid response to the cardiomyopathy, safe, hands-free operation, and minimal disruption of the surgical procedure. safety concerns when using the AED are also detailed.
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ranking = 2.5
keywords = operative
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5/99. Postoperative airway stenosis and stent therapy in carinal reconstruction for lung cancer.

    A 48-year-old male had adenocarcinoma of the right upper lung lobe that invaded the lower trachea. The right upper lobe, the carina, and 5 rings of the lower trachea were resected. The carina was reconstructed using end-to-end anastomosis between the trachea and right intermediate bronchus, with the left main bronchus anastomosed to the side wall of the intermediate bronchus. Two months after surgery, the right intermediate bronchus developed bronchomalacia and the tracheal anastomosis granulatory stenosis. bronchomalacia was treated with 2 expandable metallic stents, and granulatory stenosis with a Dumon stent. Although the silicone stent successfully dilated the granulatory stenosis, the metallic stents caused delayed glanulatory stenosis. We concluded that a metallic stent is not desirable for treating postreconstructive airway stenosis including bronchomalacia, whereas a Dumon stent may be effective.
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ranking = 2
keywords = operative
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6/99. airway management and transesophageal echocardiographic monitoring for pulmonary artery sling.

    pulmonary artery sling is an uncommon vascular anomaly and can be life threatening when it causes tracheal compression. We report on a 14-day-old boy who presented with respiratory distress soon after birth. A series of examinations showed tracheal stenosis due to a pulmonary artery sling. Surgery was performed with the aid of cardiopulmonary bypass. The external compression and intrisic stenosis could not be resolved by vascular surgery because of tracheal malacia and a complete tracheal ring. We recommend cutting extra holes 1 to 2 cm from the distal end of the endotracheal tube for endobronchial intubation. The airway obstruction was resolved successfully with a custom-made endobronchial tube. However, the patient died of pneumomediastinum and pneumothorax induced by barotrauma, on the fourth postoperative day.
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ranking = 0.5
keywords = operative
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7/99. Treatment of giant aortic aneurysm with tracheal compression and sternal erosion without circulatory arrest.

    Treatment of huge aneurysms involving the ascending aorta and the aortic arch with compression of the surrounding structures represents a surgical challenge. The case of a patient affected by respiratory insufficiency and sternal erosion caused by chronic giant aortic aneurysm is reported. The use of a stepwise approach and selective cerebral arterial perfusion ensured successful operative management, avoiding circulatory arrest and enabling an expeditious postoperative recovery.
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ranking = 1
keywords = operative
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8/99. Perioperative extracorporeal membrane oxygenation for tracheal reconstruction in congenital tracheal stenosis.

    The management of a critical airway in infants and toddlers with congenital tracheal stenosis (CTS) continues to be an enormous challenge to the surgeon. Until recently, this condition often proved fatal. Improvements in surgical techniques, anesthetic management, and postoperative critical care have resulted in successful outcomes in children not long ago considered untreatable. However, issues such as the best operative approach and the optimal perioperative management are still unresolved. The diagnosis of CTS, often delayed, must be considered in any infant with stridor, wheezing, cyanosis, or recurrent episodes of pneumonia. Associated anomalies are the rule, including frequently vascular rings and rarely pulmonary agenesis. These defects can be repaired with conventional ventilatory support under cardiopulmonary bypass, or using extracorporeal membrane oxygenation (ECMO). We report our experience in which ECMO was used to support two patients with CTS during the perioperative period. ECMO proved to be both safe and practical, allowing unrushed, precise repair of the tracheal stenosis and providing brief postoperative support. Perioperative outcomes were excellent, although one of our patients died months after the repair. A review of the literature and our experience in which ECMO was used to provide cardiopulmonary support during repair of CTS showed uniformly successful perioperative outcomes.
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ranking = 5.5
keywords = operative
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9/99. Slide tracheoplasty for congenital tracheal stenosis: a case report.

    BACKGROUND/PURPOSE: A variety of techniques have been used to manage pediatric congenital tracheal stenosis. The authors report the technique of slide tracheoplasty for a child with long congenital tracheal stenosis. methods: A 2-year-old male presented with a history of stridor with feeding. bronchoscopy findings showed 50% stenosis from complete cartilaginous rings, extending from 2.5 cm below the vocal cords to 2 cm above the carina. Through a neck incision, the trachea was exposed from the cricoid to both bronchi and transected at the midpoint of the stenosis. The upper trachea was split anteriorly to the area of stenosis just below the cricoid. The lower trachea was split posteriorly in the midline. Posterior dissection allowed sliding and anastomosis of both tracheal segments while the lateral vascular supply was left intact. A brace was placed to maintain cervical flexion, and the patient underwent extubation in the operating room. RESULTS: He recovered without complication and was dis charged on postoperative day 4. CONCLUSION: Slide tracheoplasty offers several advantages for tracheal reconstruction because it is performed with the native tracheal tissues, can be accomplished through a transverse collar incision, and can repair long stenoses without significant tracheal shortening.
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ranking = 0.5
keywords = operative
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10/99. Double aortic arch: diagnosis missed for 29 years.

    Double aortic arch is a rare vascular anomaly which causes tracheal and esophageal compression usually in the first months of life. Typical symptoms in the early childhood should lead to prompt diagnosis and surgical treatment of this malformation. In adults this anomaly is extremely rare. A case of a severely 29-year-old symptomatic woman is presented. Despite characteristic symptoms, the diagnosis was missed during childhood. The importance of different diagnostic procedures and operative therapy is discussed. Preoperative angiography can be replaced by the less invasive magnetic imaging and computed tomography. Surgical operation should also be performed in oligosymptomatic patients to prevent late complications.
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ranking = 1
keywords = operative
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