Nonsurgical intervention in the resolution of acquired neonatal bronchial stenosis

Bronchoscopic balloon dilatation in the combined management of postintubation stenosis of the trachea in adults

Bronchoscopic balloon dilatation (BBD) using angioplasty balloon catheters has been employed successfully in the treatment of tracheobronchial stenoses in children and has worked with variable success in adults with bronchial stenosis. In adults with tracheal stenosis, BBD only has been reported anecdotally. In this study, experience with BBD using a valvuloplasty balloon catheter in the combined treatment (with Nd-YAG laser photoresection and stenting) of severe benign postintubation tracheal stenoses in three adults is delineated. BBD was particularly successful in establishing tracheal patency when laser photoresection was contraindicated or was too dangerous; BBD allowed easy insertion of tracheal stents and the "opening" of folded silicone stents. BBD is a simple, inexpensive, safe, and efficient adjunct in the combined treatment of severe postintubation rigid tracheal stenosis in selected adults.

Acute airway obstruction in the hospitalized infant: four hard lessons in the distal trachea

Acute obstructing lesions of the distal (lower) trachea present a unique challenge to the pediatric otolaryngologist. The small caliber of the airway and tenuous medical status of such patients test the ingenuity of the surgeon and the limits of instrumentation. This report presents the operative findings and management of four hospitalized infants with worsening respiratory distress. Difficulties encountered in maintaining airway control while diagnosing and correcting these lesions are described.

Tracheobronchography and balloon dilatation in acquired neonatal tracheal stenosis

Between 1988 and 1992, 18 mechanically ventilated newborn babies (mean weight 1300 g and gestational age 30 weeks) presented with deteriorating respiratory failure at a mean age of 29 days. All developed increased oxygen requirements, hypoxic and hypercapnic episodes, and radiological changes of fixed lobar emphysema or recurrent atelectasis which sometimes changed sides from one day to another. Tracheobronchography with iopydol-iopydone was normal in five (27%) cases, but in 13 showed tracheobronchial stenosis localised to the lower trachea (seven cases), to the right main bronchus (three cases), or including the left main bronchus (four cases). Eleven of these 13 patients underwent endoscopy and balloon dilatation of the stenotic area. Five patients died, one before endoscopy, one immediately after endoscopies, and three subsequently with severe bronchopulmonary dysplasia. The other six babies recovered without any sequelae after balloon dilatation.

Rigid bronchoscopy balloon catheter dilation for bronchial stenosis in infants

Stenosis of the tracheobronchial tree can be a life-threatening problem. Management options for symptomatic stenosis include serial dilation, cryotherapy, laser resection, and open surgical correction. Recently, balloon angioplasty catheters have been used to dilate stenotic airway segments. The experience in infants is limited and has for the most part utilized guide wires and fluoroscopy for balloon placement. We present two infants with symptomatic bronchial stenosis who underwent endoscopic angioplasty balloon catheter dilation. Operative technique involved catheter placement under direct vision with a rigid bronchoscope. Catheters (6F) with 8-mm-diameter balloons were used. Balloon expansion was controlled with a hand-held manometer. Both infants demonstrated significant lumen size improvement intraoperatively and marked clinical improvement postoperatively, substantiated by endoscopy and radiographs. One infant has required one repeat dilation and has subsequently been asymptomatic. The other infant has had no further respiratory problems. Our technique, using a rigid bronchoscope with direct visualization of catheter placement, obviates the need for guide wires and C-arm fluoroscopy as previously described. Endoscopic placement enables direct visualization of balloon position, and fine adjustments are possible if further dilation is necessary. Rigid bronchoscopic balloon catheter dilation can be a successful technique for bronchial stenosis and should be considered prior to attempting more invasive surgical correction.