1
|
Morante-Valverde R, Usategui A, López-Díaz M, Grau M, Luna-Paredes M, de Atauri ÁGD, Pablos JL, Antón-Pacheco JL. Biodegradable polydioxanone stents: histologic and structural effects in an experimental model of tracheal stenosis. Eur J Cardiothorac Surg 2024; 65:ezae095. [PMID: 38471110 DOI: 10.1093/ejcts/ezae095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/02/2024] [Accepted: 03/11/2024] [Indexed: 03/14/2024] Open
Abstract
OBJECTIVES To evaluate the biologic impact of polydioxanone (PDO) stenting in an animal model of inflammatory tracheal stenosis (TS). Additionally, to compare these results with those obtained in the same model without a stent and after placing one PDO stent in a healthy trachea. METHODS 40 adult NZ rabbits were distributed into 3 groups: Group A, 8 animals with a healthy trachea and a PDO stent; group B, 17 rabbits with a TS and no stent; and group C, 15 animals with TS and a PDO stent. Histopathological studies included Masson's trichrome staining for submucosal fibrosis and Safranin O to assess structural integrity of cartilage. Morphometric analyses were performed in the 3 groups. RESULTS Stent placement was successful in every case. Histological studies did not show a significant increase in tracheal wall collagen area and cartilage structure was not modified in those rabbits with a PDO stent, even in a TS scenario. Stent implantation permitted recovery of normal tracheal lumen levels in the TS model. CONCLUSIONS PDO stenting in the normal trachea and in a model of TS neither caused increase in the collagen matrix nor modification of the cartilaginous support. Additionally, radial force exhibited by PDO stents was effective in restoring normal tracheal lumen when placed in a stenotic lesion. These findings suggest that they may be safe and useful in the setting of an acquired TS.
Collapse
Affiliation(s)
- Rocío Morante-Valverde
- Pediatric Surgery Division & Pediatric Airway Unit, Hospital Universitario 12 de Octubre, Avda. de Córdoba s/n, Madrid 28041, Universidad Complutense de Madrid, Spain
| | - Alicia Usategui
- Inflammatory and Autoimmune Diseases Research Group, Instituto de Investigación Hospital U, 12 de Octubre (imas12), Avda. de Córdoba s/n, Madrid, 28041, Spain
| | - María López-Díaz
- Pediatric Surgery Division & Pediatric Airway Unit, Hospital Universitario 12 de Octubre, Avda. de Córdoba s/n, Madrid 28041, Universidad Complutense de Madrid, Spain
| | - Montserrat Grau
- Research Center, Veterinary Unit, Instituto de Investigación Hospital U, 12 de Octubre (imas12)' Avda. de Córdoba s/n, Madrid, 28041, Spain
| | - MaCarmen Luna-Paredes
- Pulmonary Unit, Division of Pediatrics, Hospital Universitario 12 de Octubre, Avda. de Córdoba s/n, Madrid, 28041, Spain
| | - Álvaro Gimeno-Díaz de Atauri
- Pulmonary Unit, Division of Pediatrics, Hospital Universitario 12 de Octubre, Avda. de Córdoba s/n, Madrid, 28041, Spain
| | - José L Pablos
- Inflammatory and Autoimmune Diseases Research Group, Instituto de Investigación Hospital U, 12 de Octubre (imas12), Avda. de Córdoba s/n, Madrid, 28041, Spain
| | - Juan L Antón-Pacheco
- Pediatric Surgery Division & Pediatric Airway Unit, Hospital Universitario 12 de Octubre, Avda. de Córdoba s/n, Madrid 28041, Universidad Complutense de Madrid, Spain
- Inflammatory and Autoimmune Diseases Research Group, Instituto de Investigación Hospital U, 12 de Octubre (imas12), Avda. de Córdoba s/n, Madrid, 28041, Spain
| |
Collapse
|
2
|
López-Díaz M, Antón-Pacheco JL, Gallego-Herrero C, Enguita-Vals A, Cano-Novillo I, Morante-Valverde R, Galindo-Izquierdo A. Diagnostic accuracy of imaging compared to histology in congenital lung malformations. An Pediatr (Barc) 2023; 99:304-311. [PMID: 37867012 DOI: 10.1016/j.anpede.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/30/2023] [Accepted: 09/04/2023] [Indexed: 10/24/2023] Open
Abstract
INTRODUCTION The aim of this study was to evaluate the accuracy of imaging tests (prenatal ultrasound [US] and postnatal computed tomography [CT]) in comparison to histology for diagnosis of congenital lung malformations (CLMs). MATERIAL AND METHODS Retrospective study of patients with a prenatal diagnosis of CLM whose postnatal follow-up included thoracic CT scan and histological examination of the lesion. We collected data on demographic variables, gestational age at diagnosis, US findings and the history of multiple gestation. We used the kappa coefficient to determine the level of agreement between the findings of prenatal US and postnatal tests (CT and histology).We analysed paired data on the size of the lesion, its location and the presence or absence of systemic arterial vascularization. RESULTS The sample included 56 patients with 57 lesions. The mean gestational age at diagnosis was 22.42 weeks (SD, 3.94) and 57% were male. Malformations most frequently involved the left lung and the lower lobes. The agreement between CT and histology in the detection of cystic lesions was moderate (κ = 0.55) but stronger compared to the agreement between US and histology (κ = 0.10). The agreement between CT and histology was substantial (κ = 0.66) in the detection of systemic vascularization of the lesion and stronger compared to the agreement between US and histology. Both imaging methods were highly accurate in the identification of the location of the pulmonary lesions. CONCLUSIONS postnatal CT offers a substantial concordance with histological findings, especially in the detection of systemic vascularization, and an accurate prediction of the anatomy of the lesion.
Collapse
Affiliation(s)
- María López-Díaz
- Pediatric Surgery Division. Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Juan L Antón-Pacheco
- Pediatric Surgery Division. Hospital Universitario 12 de Octubre, Madrid, Spain.
| | | | | | | | | | | |
Collapse
|
3
|
Morante-Valverde R, Usategui A, López M, Grau M, Luna-Paredes MC, Albi S, Alonso-Riaño M, Pablos JL, Antón-Pacheco JL. Histological and structural effects of biodegradable polydioxanone stents in the rabbit trachea. Eur J Cardiothorac Surg 2022; 62:6628586. [PMID: 35781568 DOI: 10.1093/ejcts/ezac380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/03/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the potential biologic effects caused by successive placement of biodegradable polydioxanone (PDO) stents in the rabbit trachea. PDO stents could eventually induce a fibroproliferative reaction in the submucosa that could be beneficial in the treatment of malacia due to an increase in its consistency without impairing the tracheal lumen. METHODS Sixteen adult NZ rabbits were distributed into 3 groups with different survival times according to the number of stents placed: One stent (14 weeks), 2 stents (28 w.), and 3 stents (42 w.). Stent insertion was performed endoscopically in the cervical trachea of the animal. Histopathological studies included Masson's trichrome staining for submucosal fibrosis and Safranin O to assess structural integrity of cartilage. Potential inflammatory changes were analysed by means of immunohistochemistry determining the number of CD45 positive cells. RESULTS Stent placement was successful in every case. Histological studies did not show a statistically significant increase in tracheal wall collagen area and cartilage structure was not modified in those rabbits with one or more PDO stents inserted compared to non-stented tracheal sections. Furthermore, no statistically significant changes in the number of CD45+ cells were observed in stented tracheal segments compared to normal tracheal tissues. CONCLUSIONS According to our data, successive PDO stenting caused mild inflammatory changes in the tracheal wall, no increase in the collagen matrix, and the cartilaginous support was not modified during a long follow-up period (up to 42 weeks). These findings suggest that they may be safe and show good biocompatibility in the long-term.
Collapse
Affiliation(s)
- Rocío Morante-Valverde
- Pediatric Surgery Division & Pediatric Airway Unit. Hospital Universitario 12 de Octubre. Avda. de Córdoba s/n, Madrid 28041. Universidad Complutense de Madrid. Spain
| | - Alicia Usategui
- Inflammatory and Autoimmune Diseases Research Group. Instituto de Investigación Hospital U. 12 de Octubre (imas12). Avda. de Córdoba s/n, Madrid 28041. Spain
| | - María López
- Pediatric Surgery Division & Pediatric Airway Unit. Hospital Universitario 12 de Octubre. Avda. de Córdoba s/n, Madrid 28041. Universidad Complutense de Madrid. Spain
| | - Montserrat Grau
- Research Center, Veterinary Unit. Instituto de Investigación Hospital U. 12 de Octubre (imas12). Avda. de Córdoba s/n, Madrid 28041. Spain
| | - Ma Carmen Luna-Paredes
- Pulmonary Unit, Division of Pediatrics. Hospital Universitario 12 de Octubre. Avda. de Córdoba s/n, Madrid 28041. Spain
| | - Salomé Albi
- Pulmonary Unit, Division of Pediatrics. Hospital Universitario 12 de Octubre. Avda. de Córdoba s/n, Madrid 28041. Spain
| | - Marina Alonso-Riaño
- Division of Pathology. Hospital Universitario 12 de Octubre. Avda. de Córdoba s/n, Madrid 28041. Spain
| | - José L Pablos
- Inflammatory and Autoimmune Diseases Research Group. Instituto de Investigación Hospital U. 12 de Octubre (imas12). Avda. de Córdoba s/n, Madrid 28041. Spain
| | - Juan L Antón-Pacheco
- Pediatric Surgery Division & Pediatric Airway Unit. Hospital Universitario 12 de Octubre. Avda. de Córdoba s/n, Madrid 28041. Universidad Complutense de Madrid. Spain.,Inflammatory and Autoimmune Diseases Research Group. Instituto de Investigación Hospital U . 12 de Octubre (imas12). Avda. de Córdoba s/n, Madrid, 28041, . Spain
| |
Collapse
|
4
|
Antón-Pacheco JL, Martín-Alelú R, López M, Morante R, Merino-Mateo L, Barrero S, Castilla R, Cano I, García A, Gómez A, Luna-Paredes MC. Foreign body aspiration in children: Treatment timing and related complications. Int J Pediatr Otorhinolaryngol 2021; 144:110690. [PMID: 33799103 DOI: 10.1016/j.ijporl.2021.110690] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/03/2021] [Accepted: 03/18/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND/PURPOSE The aims of this study were to describe our experience in the management of FB aspiration in children, focusing on the eventual association between delay in treatment and the development of complications, and to determine if the incidence of this emergency had decreased in the last 10 years. METHODS Retrospective study of children with a diagnosis of FB aspiration managed between 1999 and 2019 at a tertiary care referral hospital. The following data were collected: demographics, clinical presentation, radiological findings, endoscopic technique, type of FB, time elapsed between the aspiration episode and treatment, and complications. Main outcome measures were the rate of complications (intraoperative and long-term) in the cohort of patients with delay in treatment (>72 h), and the incidence of FB aspiration in each of the two historical subgroups of the study. RESULTS The study included 130 patients, 66.2% male, with a median age of 24 months. Cough was the most frequent symptom (76.1%) and unilateral air trapping was the most common radiological finding (48.8%). Removal of FB was performed with rigid bronchoscopy in every case. The most common type of FB was organic (73%) and located in the right bronchial system (47.7%). The global rate of complications was 16.1%. Patients with a delay in treatment beyond 72 h from the aspiration episode showed a statistically significant risk of developing both intraoperative and postoperative complications. Additionally, we have stated that the incidence of FB aspiration in our community has decreased by 44.4% in the last 10 years. CONCLUSIONS The incidence of FB aspiration has remarkably decreased in our environment in the last decade. Delay in treatment placed our patients at a significant higher risk of developing complications both during the bronchoscopic procedure and in the long-term.
Collapse
Affiliation(s)
- Juan L Antón-Pacheco
- Division of Pediatric Surgery & Pediatric Airway Unit, Hospital U, 12 de Octubre, Madrid, Spain; Universidad Complutense de Madrid, Spain.
| | | | - María López
- Division of Pediatric Surgery & Pediatric Airway Unit, Hospital U, 12 de Octubre, Madrid, Spain
| | - Rocío Morante
- Division of Pediatric Surgery & Pediatric Airway Unit, Hospital U, 12 de Octubre, Madrid, Spain
| | - Lara Merino-Mateo
- Division of Pediatric Surgery, Hospital U. 12 de Octubre, Madrid, Spain
| | - Sergio Barrero
- School of Medicine, Universidad Complutense de Madrid, Spain
| | - Rubén Castilla
- School of Medicine, Universidad Complutense de Madrid, Spain
| | - Indalecio Cano
- Division of Pediatric Surgery, Hospital U. 12 de Octubre, Madrid, Spain
| | - Araceli García
- Division of Pediatric Surgery, Hospital U. 12 de Octubre, Madrid, Spain
| | - Andrés Gómez
- Division of Pediatric Surgery, Hospital U. 12 de Octubre, Madrid, Spain
| | - Ma Carmen Luna-Paredes
- Division of Pediatric Surgery & Pediatric Airway Unit, Hospital U, 12 de Octubre, Madrid, Spain
| |
Collapse
|
5
|
Moreno M, Castillo-Corullón S, Pérez-Ruiz E, Luna MC, Antón-Pacheco JL, Mondejar-Lopez P, De-la-Serna O, Villa JR, Osona B, Torres-Borrego J, Santiago-Burruchaga M, Asensio O, Andres-Martin A, Delgado-Pecellin I, González Y, Palmero A, Escribano A. Spanish multicentre study on morbidity and pathogenicity of tracheal bronchus in children. Pediatr Pulmonol 2019; 54:1610-1616. [PMID: 31328420 DOI: 10.1002/ppul.24435] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 06/11/2019] [Indexed: 11/11/2022]
Abstract
Tracheal bronchus (TRB) has been generally considered an anatomical variant of the tracheobronchial tree without a precise pathological effect. Its prevalence is estimated to be between 0.2% to 3% of all children undergoing bronchoscopy and scientific information has been limited to case reports or small case series. Our working hypothesis was that TRB could trigger by itself recurrent or persistent respiratory symptoms. The objective of this retrospective and multicentre study of children with a diagnosis of TRB, coming from the main paediatric pulmonology units of Spain, was to determine the anatomical and clinical characteristics, including comorbidities, of TRB in childhood and their impact in the patients' clinical outcomes. One hundred thirty-three patients from 13 institutions were included in the study. Mean diagnostic age was 3.4 years and flexible bronchoscopy was the initial diagnostic method in 85% of cases. All TRB were located on the right wall of the trachea: 76% in the lower third and 24% in the carina. The most common clinical manifestations were obstructive bronchitis (53.3%) and recurrent pneumonia (46.6%), usually affecting the right upper lobe. Regarding associated anomalies, 33% had tracheomalacia, 32% congenital cardiovascular malformations, 28% gastroesophageal reflux, 22.5% congenital tracheal stenosis, and 8.3% Down syndrome. This series appears to be the most extensive published to date addressing this topic and, according to our data, TRB does not appear to be a mere incidental finding but is more likely linked to a wide range of congenital anomalies and contributes by itself to the recurrent respiratory symptomatology that these children exhibit.
Collapse
Affiliation(s)
- Marcela Moreno
- Division of Pediatrics, Paediatric Pneumology Unit, University Clinic Hospital, Valencia, Spain
| | | | - Estela Pérez-Ruiz
- Division of Pediatrics, Regional University Hospital of Málaga, Málaga, Spain
| | - Maria Carmen Luna
- Paediatric Airway Unit, University Hospital 12 de Octubre, Madrid, Spain
| | | | | | - Olga De-la-Serna
- Division of Pediatrics, La Paz University Hospital, Madrid, Spain
| | | | - Borja Osona
- Division of Pediatrics, Son Espases Hospital, Palma, Spain
| | | | | | - Oscar Asensio
- Division of Pediatrics, Cruces University Hospital, Bilbao, Spain
| | - Anselmo Andres-Martin
- Division of Pediatrics, Parc Taulí Hospital, Barcelona, Spain.,Division of Pediatrics, Virgen Macarena Hospital, Sevilla, Spain
| | | | | | - Ana Palmero
- Division of Pediatrics, Paediatric Pneumology Unit, University Clinic Hospital, Valencia, Spain
| | - Amparo Escribano
- Division of Pediatrics, Paediatric Pneumology Unit, University Clinic Hospital, Valencia, Spain.,Division of Pediatrics, University of Valencia, Valencia, Spain
| |
Collapse
|
6
|
Wallis C, Alexopoulou E, Antón-Pacheco JL, Bhatt JM, Bush A, Chang AB, Charatsi AM, Coleman C, Depiazzi J, Douros K, Eber E, Everard M, Kantar A, Masters IB, Midulla F, Nenna R, Roebuck D, Snijders D, Priftis K. ERS statement on tracheomalacia and bronchomalacia in children. Eur Respir J 2019; 54:13993003.00382-2019. [PMID: 31320455 DOI: 10.1183/13993003.00382-2019] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 05/16/2019] [Indexed: 01/20/2023]
Abstract
Tracheomalacia and tracheobronchomalacia may be primary abnormalities of the large airways or associated with a wide variety of congenital and acquired conditions. The evidence on diagnosis, classification and management is scant. There is no universally accepted classification of severity. Clinical presentation includes early-onset stridor or fixed wheeze, recurrent infections, brassy cough and even near-death attacks, depending on the site and severity of the lesion. Diagnosis is usually made by flexible bronchoscopy in a free-breathing child but may also be shown by other dynamic imaging techniques such as low-contrast volume bronchography, computed tomography or magnetic resonance imaging. Lung function testing can provide supportive evidence but is not diagnostic. Management may be medical or surgical, depending on the nature and severity of the lesions, but the evidence base for any therapy is limited. While medical options that include bronchodilators, anti-muscarinic agents, mucolytics and antibiotics (as well as treatment of comorbidities and associated conditions) are used, there is currently little evidence for benefit. Chest physiotherapy is commonly prescribed, but the evidence base is poor. When symptoms are severe, surgical options include aortopexy or posterior tracheopexy, tracheal resection of short affected segments, internal stents and external airway splinting. If respiratory support is needed, continuous positive airway pressure is the most commonly used modality either via a face mask or tracheostomy. Parents of children with tracheobronchomalacia report diagnostic delays and anxieties about how to manage their child's condition, and want more information. There is a need for more research to establish an evidence base for malacia. This European Respiratory Society statement provides a review of the current literature to inform future study.
Collapse
Affiliation(s)
- Colin Wallis
- Respiratory Medicine Unit, Great Ormond Street Hospital for Children, London, UK
| | - Efthymia Alexopoulou
- 2nd Radiology Dept, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Juan L Antón-Pacheco
- Pediatric Airway Unit and Pediatric Surgery Division, Universidad Complutense de Madrid, Madrid, Spain
| | - Jayesh M Bhatt
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
| | - Andrew Bush
- Imperial College London and Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Anne B Chang
- Dept of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia.,Centre for Children's Health Research, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.,Child Health Division, Menzies School of Health Research, Charles Darwin University, Casuarina, Australia
| | | | | | - Julie Depiazzi
- Physiotherapy Dept, Perth Children's Hospital, Perth, Australia
| | - Konstantinos Douros
- Allergology and Pulmonology Unit, 3rd Paediatric Dept, National and Kapodistrian University of Athens, Athens, Greece
| | - Ernst Eber
- Division of Paediatric Pulmonology and Allergology, Dept of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Mark Everard
- Division of Paediatrics, University of Western Australia, Perth Children's Hospital, Perth, Australia
| | - Ahmed Kantar
- Pediatric Asthma and Cough Centre, Istituti Ospedalieri Bergamaschi, University and Research Hospitals, Bergamo, Italy
| | - Ian B Masters
- Dept of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia.,Centre for Children's Health Research, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Fabio Midulla
- Dept of Paediatrics, "Sapienza" University of Rome, Rome, Italy
| | - Raffaella Nenna
- Dept of Paediatrics, "Sapienza" University of Rome, Rome, Italy.,Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, USA
| | - Derek Roebuck
- Interventional Radiology Dept, Great Ormond Street Hospital, London, UK
| | - Deborah Snijders
- Dipartimento Salute della Donna e del Bambino, Università degli Studi di Padova, Padova, Italy
| | - Kostas Priftis
- Allergology and Pulmonology Unit, 3rd Paediatric Dept, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
7
|
Redondo-Sedano J, Antón-Pacheco JL, Valverde RM, Díaz ML, Paredes CL, Guardia LM, Alelu RM, Huerta IJ, Gordo MIB, Fraile AG. Laryngeal stenosis in children: Types, grades and treatment strategies. J Pediatr Surg 2019; 54:1933-1937. [PMID: 30503025 DOI: 10.1016/j.jpedsurg.2018.09.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/15/2018] [Accepted: 09/17/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Laryngeal stenosis is infrequent in children and usually secondary to endotracheal intubation. The aims of this study were to review the outcomes of the distinct endoscopic and surgical procedures and to suggest a technical modification for one of them. METHODS Retrospective review of patients with the diagnosis of laryngeal stenosis treated in an academic tertiary care institution between 2000 and 2017. The following variables were analyzed: demographic data, endoscopic findings including anatomic type and severity of the lesion, associated anomalies, type of treatment, outcomes, and time of follow-up. RESULTS Seventy-eight children were included in the study (39 boys) with a median age at diagnosis of 9 months, and 33 (42.3%) showed an associated anomaly. Lesions were acquired in 84.6% of cases and the subglottic region was most frequently involved (77%). Thirty patients (38.4%) had a severe stenosis (Myer-Cotton grades III and IV) and a tracheotomy was performed as an initial treatment in 38 patients (48.7%). Overall, 91% of endoscopically or surgically treated patients showed a good outcome and the decannulation rate in the series was 79.4%. Fourteen patients were managed conservatively. Median follow-up was 29 months (I.R. 10-60 m.) CONCLUSIONS: Laryngeal stenosis in children is usually acquired and exhibit a wide range of anatomic presentations. Endoscopic therapeutic procedures may be useful in the management of low grade immature stenosis. Reconstructive surgical techniques may provide a high success rate with an appropriate selection of candidates.
Collapse
Affiliation(s)
- Jesús Redondo-Sedano
- Pediatric Surgery Division, Hospital Universitario 12 de Octubre, Avda. De Córdoba s/n, Madrid 28041, Spain
| | - Juan L Antón-Pacheco
- Pediatric Airway Unit and Pediatric Surgery Division, Hospital Universitario 12 de Octubre, Avda. De Córdoba s/n, Madrid 28041, Spain, Universidad Complutense de Madrid.
| | - Rocio Morante Valverde
- Pediatric Airway Unit and Pediatric Surgery Division, Hospital Universitario 12 de Octubre, Avda. De Córdoba s/n, Madrid 28041, Spain
| | - María López Díaz
- Pediatric Airway Unit and Pediatric Surgery Division, Hospital Universitario 12 de Octubre, Avda. De Córdoba s/n, Madrid 28041, Spain
| | - Carmen Luna Paredes
- Pediatric Airway Unit and Division of Pediatrics, Hospital Universitario 12 de Octubre, Avda. De Córdoba s/n, Madrid 28041, Spain
| | - Leonor Melero Guardia
- Pediatric Surgery Division, Hospital Universitario 12 de Octubre, Avda. De Córdoba s/n, Madrid 28041, Spain
| | - Rubén Martín Alelu
- Pediatric Surgery Division, Hospital Universitario 12 de Octubre, Avda. De Córdoba s/n, Madrid 28041, Spain
| | - Ignacio Jiménez Huerta
- Pediatric Airway Unit and ENT Division, Hospital Universitario 12 de Octubre, Avda. De Córdoba s/n, Madrid 28041, Spain
| | | | - Andrés Gómez Fraile
- Pediatric Surgery Division, Hospital Universitario 12 de Octubre, Avda. De Córdoba s/n, Madrid 28041, Spain
| |
Collapse
|
8
|
García-Torres E, Antón-Pacheco JL, Luna-Paredes MC, Morante-Valverde R, Ezquerra-Pozo E, Ferrer-Martínez A, Villafruela MA, Jiménez-Huerta I, López-Díaz M, Carrillo-Arroyo I, Boni L. Vocal cord paralysis after cardiovascular surgery in children: incidence, risk factors and diagnostic options. Eur J Cardiothorac Surg 2019; 57:359-365. [DOI: 10.1093/ejcts/ezz190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 05/12/2019] [Accepted: 05/30/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
OBJECTIVES
The aim of this study was to assess the incidence of vocal cord paralysis (VCP) in children after cardiovascular surgery. The secondary aims were to identify the factors potentially associated with VCP and to assess the diagnostic utility of laryngeal ultrasound (US).
METHODS
This study is a retrospective review of patients who underwent aortic repair, patent ductus arteriosus ligation and left pulmonary artery surgeries from 2007 to 2017. The following data were collected: patient demographics, gestational age, weight and age at surgery, comorbidities, cardiovascular anomaly and type of procedure, laryngoscopic and US evaluation results. Univariable and multivariable logistic regression models were used to identify the variables associated with VCP.
RESULTS
Two hundred and six patients were included in the study. Seventy-two patients (35%) were preterm and 32.5% showed comorbidities. At surgery, median age and weight were 0.6 months [interquartile range (IQR) 0.3–2.1] and 3.0 kg (IQR 1.3–4.0), respectively. Postoperatively, symptomatic patients underwent endoscopic evaluation and VCP was detected in 25 cases (12.1%). Laryngeal US was performed in 8 of these showing an excellent diagnostic relationship. On univariable analysis, factors significantly associated with VCP were prematurity, young age and lower weight at surgery and the presence of comorbidities. The presence of comorbidities and weight at surgery exhibited a significant risk of developing VCP postoperatively on multivariable analysis.
CONCLUSIONS
VCP is not an unusual complication of cardiovascular surgery. Certain factors were associated with VCP development but only the presence of comorbidities and weight at surgery were statistically significant on multivariable analysis. Flexible laryngoscopy is the standard diagnostic technique and laryngeal US appears to be a reliable complement.
Collapse
Affiliation(s)
- Enrique García-Torres
- Pediatric Cardiovascular Surgery Unit, Pediatric Institute of the Heart, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Juan L Antón-Pacheco
- Pediatric Airway Unit, Division of Pediatric Surgery, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Mª Carmen Luna-Paredes
- Pediatric Airway Unit, Division of Pediatrics, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Rocío Morante-Valverde
- Pediatric Airway Unit, Division of Pediatric Surgery, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Elena Ezquerra-Pozo
- Division of Pediatric Surgery, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Alicia Ferrer-Martínez
- Division of Pediatric Surgery, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Miguel A Villafruela
- Pediatric Airway Unit, Division of Otorhinolaryngology, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Ignacio Jiménez-Huerta
- Pediatric Airway Unit, Division of Otorhinolaryngology, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - María López-Díaz
- Pediatric Airway Unit, Division of Pediatric Surgery, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Isabel Carrillo-Arroyo
- Division of Pediatric Surgery, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Lorenzo Boni
- Pediatric Cardiovascular Surgery Unit, Pediatric Institute of the Heart, Hospital Universitario 12 de Octubre, Madrid, Spain
| |
Collapse
|
9
|
Eber E, Antón-Pacheco JL, de Blic J, Doull I, Faro A, Nenna R, Nicolai T, Pohunek P, Priftis KN, Serio P, Coleman C, Masefield S, Tonia T, Midulla F. ERS statement: interventional bronchoscopy in children. Eur Respir J 2017; 50:50/6/1700901. [DOI: 10.1183/13993003.00901-2017] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 08/08/2017] [Indexed: 12/25/2022]
Abstract
Paediatric airway endoscopy is accepted as a diagnostic and therapeutic procedure, with an expanding number of indications and applications in children. The aim of this European Respiratory Society task force was to produce a statement on interventional bronchoscopy in children, describing the evidence available at present and current clinical practice, and identifying areas deserving further investigation. The multidisciplinary task force panel performed a systematic review of the literature, focusing on whole lung lavage, transbronchial and endobronchial biopsy, transbronchial needle aspiration with endobronchial ultrasound, foreign body extraction, balloon dilation and occlusion, laser-assisted procedures, usage of airway stents, microdebriders, cryotherapy, endoscopic intubation, application of drugs and other liquids, and caregiver perspectives. There is a scarcity of published evidence in this field, and in many cases the task force had to resort to the collective clinical experience of the committee to develop this statement. The highlighted gaps in knowledge underline the need for further research and serve as a call to paediatric bronchoscopists to work together in multicentre collaborations, for the benefit of children with airway disorders.
Collapse
|
10
|
Affiliation(s)
- Juan L Antón-Pacheco
- Pediatric Airway Unit, Division of Pediatric Surgery, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Rocio Morante
- Pediatric Airway Unit, Division of Pediatric Surgery, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| |
Collapse
|
11
|
Antón-Pacheco JL, Usategui A, Martínez I, García-Herrero CM, Gamez AP, Grau M, Martínez AM, Rodríguez-Peralto JL, Pablos JL. TGF-β antagonist attenuates fibrosis but not luminal narrowing in experimental tracheal stenosis. Laryngoscope 2016; 127:561-567. [DOI: 10.1002/lary.26402] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 09/16/2016] [Accepted: 10/04/2016] [Indexed: 11/09/2022]
Affiliation(s)
| | - Alicia Usategui
- Grupo de Enfermedades Inflamatorias y Autoinmunes, Instituto de Investigación Hospital 12 de Octubre (Imas12); Universidad Complutense de Madrid; Madrid Spain
| | - Iván Martínez
- Servicio de Cirugía Torácica; Hospital 12 de Octubre; Madrid Spain
| | - Carmen M. García-Herrero
- Grupo de Enfermedades Inflamatorias y Autoinmunes, Instituto de Investigación Hospital 12 de Octubre (Imas12); Universidad Complutense de Madrid; Madrid Spain
| | - Antonio P. Gamez
- Servicio de Cirugía Torácica; Hospital 12 de Octubre; Madrid Spain
| | - Montserrat Grau
- Unidad de Animalario y Quirófanos Experimentales, Instituto de Investigación Hospital 12 de Octubre (Imas12); Universidad Complutense de Madrid; Madrid Spain
| | - Ana M. Martínez
- Universidad Francisco de Vitoria, Facultad de Ciencias Sanitarias, Escuela de Farmacia; Universidad Complutense de Madrid; Madrid Spain
- Departamento de Bioquímica y Biología Molecular, Facultad de Medicina; Universidad Complutense de Madrid; Madrid Spain
| | | | - José L. Pablos
- Grupo de Enfermedades Inflamatorias y Autoinmunes, Instituto de Investigación Hospital 12 de Octubre (Imas12); Universidad Complutense de Madrid; Madrid Spain
- Servicio de Reumatología, Hospital 12 de Octubre; Universidad Complutense de Madrid; Madrid Spain
| |
Collapse
|
12
|
Abstract
Tracheobronchial obstruction is infrequent in children and still remains a challenging matter of concern. Management alternatives vary from conservative treatment to complex surgical techniques or endoscopic interventional procedures. Airway stenting in children is relatively recent and follows the trail of the experience in adult patients. Nevertheless, there are basic differences between both age groups like the benign nature of most obstructions and the small size of the pediatric airway. These specific features raise the issues of the precise role of tracheobronchial stenting in children and the selection of the most adequate device. Stents fall into four main categories according to the material they are made of: metallic, plastic, hybrid, and biodegradable. Each type has its own advantages and drawbacks so the ideal stent is not yet available. Despite increasing experience with stenting, definite clinical criteria for their use in children are yet to be established. Even so, there seems to be a basic general agreement that stents may play a role in particular clinical settings in which there are no other therapeutic options.
Collapse
Affiliation(s)
- Juan L Antón-Pacheco
- Pediatric Airway Unit, Division of Pediatric Surgery, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, c/Vallehermoso 20. 7º A, izda, Madrid 28015, Spain.
| |
Collapse
|
13
|
Antón-Pacheco JL, Luna C, García E, López M, Morante R, Tordable C, Palacios A, de Miguel M, Benavent I, Gómez A. Initial experience with a new biodegradable airway stent in children: Is this the stent we were waiting for? Pediatr Pulmonol 2016; 51:607-12. [PMID: 26584412 DOI: 10.1002/ppul.23340] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 10/07/2015] [Accepted: 11/02/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To report our experience with a new type of biodegradable airway stent in the setting of severe tracheobronchial obstruction in children. DESIGN AND METHODOLOGY We conducted a retrospective and prospective (since June 2014) study of pediatric patients with severe airway obstruction treated with biodegradable stents in our institution between 2012 and 2015. The following data were collected: demographics, indication for stenting, bronchoscopic findings, insertion technique complications, clinical outcome, stent related complications, re-stenting, and time of follow-up. RESULTS Thirteen custom-made polydioxanone stents were placed in four infants (mean age, 4 months) with severe tracheobronchial obstruction: tracheomalacia (two patients), bronchomalacia (1), and diffuse tracheal stenosis (1). All the stents were bronchoscopically inserted uneventfully. Immediate and maintained clinical improvement was observed in every case. No major stent related complications have occurred and only mild or moderate granulation tissue was observed during surveillance bronchoscopy. Two patients required repeated stenting as expected. All the patients are alive and in a good respiratory condition with a follow-up ranging from 5 to 40 months. CONCLUSIONS Biodegradable airway stents seem to be safe, effective, and cause fewer complications than other types of stents. They can be an alternative to the classic metallic or plastic stents for severe tracheal stenosis or malacia in small children. More experience is needed in order to establish the definite clinical criteria for their use in pediatric patients. Pediatr Pulmonol. 2016;51:607-612. © 2015 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Juan L Antón-Pacheco
- Pediatric Airway Unit, Division of Pediatric Surgery, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - Carmen Luna
- Pediatric Airway Unit, Division of Pediatric Surgery, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - Enrique García
- Pediatric Institute of the Heart, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - María López
- Pediatric Airway Unit, Division of Pediatric Surgery, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - Rocío Morante
- Pediatric Airway Unit, Division of Pediatric Surgery, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - Cristina Tordable
- Pediatric Airway Unit, Division of Pediatric Surgery, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - Alba Palacios
- Pediatric Intensive Care Unit, Division of Pediatrics, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - Mónica de Miguel
- Division of Pediatric Anesthesiology, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - Isabel Benavent
- Pediatric Airway Unit, Division of Pediatric Surgery, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - Andrés Gómez
- Pediatric Airway Unit, Division of Pediatric Surgery, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain
| |
Collapse
|
14
|
Luna-Paredes C, Antón-Pacheco JL, García Hernández G, Martínez Gimeno A, Romance García AI, García Recuero II. Screening for symptoms of obstructive sleep apnea in children with severe craniofacial anomalies: assessment in a multidisciplinary unit. Int J Pediatr Otorhinolaryngol 2012; 76:1767-70. [PMID: 22980525 DOI: 10.1016/j.ijporl.2012.08.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 08/14/2012] [Accepted: 08/16/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To assess the incidence of airway obstruction symptoms and the presence of obstructive sleep apnea in children with severe craniofacial anomalies by a proactive screening program using a standard questionnaire and cardiorespiratory polygraphy. PATIENTS AND METHODS Children with severe craniofacial anomalies referred to our paediatric airway unit from February 2001 to June 2011 were eligible to be included in this retrospective, single centre study. Symptoms of airway obstruction were proactively investigated using the shorter version of the Pediatric Sleep Questionnaire (PSQ). Obstructive sleep apnea was assessed by means of cardiorespiratory polygraphy. Demographic data and reason for referral were also recorded. Primary outcomes were the prevalence of symptoms of airway obstruction and OSA. RESULTS 44 children (24 girls) with severe craniofacial anomalies (15 Crouzon, 13 Apert, 9 Goldenhar, 5 Treacher-Collins, 2 Pfeiffer) were included, at a mean age of 5 years (range 8 months to 14 years). Reason for referral was routine follow up in 30 patients and overt OSA symptoms and signs in the remaining 14. PSQ results showed symptoms of airway obstruction in 82% of patients, being snoring the most frequent symptom (64.1%) followed by apneas (33.3%). Polygraphic studies showed inconclusive results in 8 children (18.2%), normal apnea-hypopnea index (AHI) in 16 (36.4%), mild obstructive sleep apnea in 9 (20.4%), moderate in 4 (9.1%) and severe obstructive sleep apnea in 7 (15.9%). CONCLUSIONS Children with craniofacial anomalies have a high prevalence of symptoms of airway obstruction and obstructive sleep apnea that support a proactive screening strategy in this highly selected population.
Collapse
Affiliation(s)
- Carmen Luna-Paredes
- Pediatric Airway Unit, Division of Pediatric Pulmonology and Division of Pediatric Surgery, Hospital Universitario "12 de Octubre", Universidad Complutense de Madrid, Madrid, Spain.
| | | | | | | | | | | |
Collapse
|
15
|
Antón-Pacheco JL. [Paediatric bronchoscopy: from where we came from, to where we are going]. An Pediatr (Barc) 2012; 77:223-5. [PMID: 22902949 DOI: 10.1016/j.anpedi.2012.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 07/09/2012] [Indexed: 11/15/2022] Open
|
16
|
Antón-Pacheco JL, Luna Paredes C, Martínez Gimeno A, García Hernández G, Martín de la Vega R, Romance García A. The role of bronchoscopy in the management of patients with severe craniofacial syndromes. J Pediatr Surg 2012; 47:1512-5. [PMID: 22901909 DOI: 10.1016/j.jpedsurg.2012.01.075] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 12/20/2011] [Accepted: 01/23/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE The purpose of this study is to assess the incidence of airway anomalies in children with severe craniofacial syndromes and to establish the role of bronchoscopy in the care of these patients. METHODS Consecutive children with craniofacial syndromes, including both bony deformities of the skull and face, in which a bronchoscopy was performed between 1995 and 2010 were retrospectively reviewed. RESULTS Thirty-six patients (22 boys, 14 girls; mean age, 39 months) were studied. Craniofacial synostosis was present in 21 patients (Crouzen syndrome, 11; Apert syndrome, 7, Pfeiffer syndrome, 3) and craniofacial dysostosis in 15 (Goldenhart syndrome, 8; Treacher Collins syndrome, 7). In 30 patients (83.3%), bronchoscopy was performed because of respiratory symptoms (apneic episodes, 22; respiratory distress, 13; stridor, 6; cyanosis, 1) and, in the remaining 6 (asymptomatic children), during guided tracheal intubation before a surgical procedure. Airway anomalies were found in 69.4% of patients (70% in symptomatic patients). Management consisted of tracheotomy in 13 patients, adenoidectomy/tonsillectomy in 13, glossopexy in 5, antireflux surgery in 3, and supraglottoplasty in 2. CONCLUSIONS Airway anomalies occurred in 70% of children with severe craniofacial syndromes and respiratory symptoms. Bronchoscopy should be performed routinely in this selected group of patients, and the entire airway must be examined. Treatment should be tailored to each individual patient.
Collapse
Affiliation(s)
- Juan L Antón-Pacheco
- Pediatric Airway Unit, Division of Pediatric Surgery, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, E-28041, Spain.
| | | | | | | | | | | |
Collapse
|
17
|
Kotecha S, Barbato A, Bush A, Claus F, Davenport M, Delacourt C, Deprest J, Eber E, Frenckner B, Greenough A, Nicholson AG, Antón-Pacheco JL, Midulla F. Congenital diaphragmatic hernia. Eur Respir J 2011; 39:820-9. [PMID: 22034651 DOI: 10.1183/09031936.00066511] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Infants with congenital diaphragmatic hernia (CDH) have significant mortality and long-term morbidity. Only 60-70% survive and usually those in high-volume centres. The current Task Force, therefore, has convened experts to evaluate the current literature and make recommendations on both the antenatal and post-natal management of CDH. The incidence of CDH varies from 1.7 to 5.7 per 10,000 live-born infants depending on the study population. Antenatal ultrasound scanning is routine and increasingly complemented by the use of magnetic resonance imaging. For isolated CDH, antenatal interventions should be considered, but the techniques need vigorous evaluation. After birth, management protocols are often used and have improved outcome in nonrandomised studies, but immediate intubation at birth and gentle ventilation are important. Pulmonary hypertension is common and its optimal management is crucial as its severity predicts the outcome. Usually, surgery is delayed to allow optimal medical stabilisation. The role of minimal invasive post-natal surgery remains to be further defined. There are differences in opinion about whether extracorporeal membrane oxygenation improves outcome. Survivors of CDH can have a high incidence of comorbidities; thus, multidisciplinary follow-up is recommended. Multicentre international trials are necessary to optimise the antenatal and post-natal management of CDH patients.
Collapse
Affiliation(s)
- S Kotecha
- Dept of Child Health, Cardiff University School of Medicine, Heath Park, Cardiff CF14 4XN, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Antón-Pacheco JL, López M, Moreno C, Bustos G. Congenital tracheal stenosis caused by a new tracheal ring malformation. J Thorac Cardiovasc Surg 2011; 141:e39-40. [PMID: 21457996 DOI: 10.1016/j.jtcvs.2011.02.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 01/31/2011] [Accepted: 02/18/2011] [Indexed: 10/18/2022]
Affiliation(s)
- Juan L Antón-Pacheco
- Division of Pediatric Surgery and Pediatric Airway Unit, Hospital Universitario 12 de Octubre, Madrid, Spain.
| | | | | | | |
Collapse
|
19
|
Antón-Pacheco JL, García-Hernández G, Villafruela MA. The management of tracheobronchial obstruction in children. Minerva Pediatr 2009; 61:39-52. [PMID: 19180001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Tracheobronchial obstruction is very uncommon in children and small infants. Stenosis and malacia, either congenital or acquired, are probably the most frequent diagnosis in this setting. Clinical symptoms are common to both airway anomalies and bronchoscopy plays a crucial role in the diagnostic work-up. Management is complex and surgeons involved in it should be familiar with multiple surgical and endoscopical techniques. Symptomatic short tracheal stenosis are best treated by means of resection and reconstruction, although endoscopic dilation or laser resection can be tried first in selected cases. In long tracheal stenosis, slide tracheoplasty is the surgical procedure of choice. Tracheobronchial malacia is usually self-limiting by the age of 3 years and most cases show mild symptoms that can be treated conservatively. In a small group of patients airway compromise is severe enough to require surgical or endoscopical treatment. Aortopexy or tracheostomy are the classic treatments for congenital tracheomalacia, but increasing experience with endoscopic airway stent placement in children is making this technique more attractive and popular. Acquired tracheomalacia is usually caused by a long-standing tracheostomy and if decannulation is impaired surgical treatment is mandatory.
Collapse
Affiliation(s)
- J L Antón-Pacheco
- Pediatric Airway Unit, Department of Pediatrics, University Hospital ''12 de Octubre'', Madrid, Spain.
| | | | | |
Collapse
|
20
|
Antón-Pacheco JL, Berchi FJ. Acquired tracheo-esophageal fistula in a child caused by an unsuspected esophageal foreign body. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.pedex.2008.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
21
|
Tejedor R, Antón-Pacheco JL, Cabezalí D, López M, Villafruela MA, Gómez A. [Surgical decannulation of children with suprastomal collapse: review of our experience]. Cir Pediatr 2007; 20:199-202. [PMID: 18351239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Suprastomal tracheal collapse (STC) may interfere with decannulation in tracheostomized patients. AIM To evaluate the role of tracheotomy technique in the ethiology of STC, and to analyze our results in the treatment of this complication. PATIENTS AND METHODS We have studied the clinical charts of tracheostomized patients in our Unit, between 1990 and 2006, who showed significant STC impairing decannulation. The following data have been taken into account: sex, age, tracheotomy indication, surgical technique, endoscopic findings, type of surgical correction, complications, result, and follow-up. RESULTS Thirteen patients have showed STC, nine girls and four boys. Average age when tracheotomy was performed was 18 months, and extended ventilatory support was the most common indication (61,5%). Tracheotomy with lateral flaps was the most frequent technique in this group of patients with STC (8 cases), whereas only one patient in whom an anterior vertical tracheal incision was performed showed this complication. In every case bronchoscopy disclosed a suprastomal tracheal obstruction of at least 50% of the lumen. Mean age when surgical decannulation was performed was 36 months (range, 12-147). Two surgical techniques have been used in the treatment of STC: anterior cricoid suspension (12 patients) and reconstruction with autologous cartilage graft (one case). A satisfactory result has been achieved in 92% of cases (one patient showed persistent collapse and the same procedure was repeated). Mean follow-is 8,6 years (range, 2 months-12 years). CONCLUSIONS STC is a type of acquired tracheomalacia and presents in around 10% of tracheostomized patients. Bronchoscopy is essential for diagnosis and to rule out other causes of failure in decannulation. Tracheotomy technique seems to have an ethiologic role, and our preferred treatment, when sufficient cartilaginous support is present, is anterior cricoid suspension.
Collapse
Affiliation(s)
- R Tejedor
- Unidad de la Vía Aérea y Servicio de Cirugía Pedidtrica, Hospital Universitario 12 de Octubre, Madrid
| | | | | | | | | | | |
Collapse
|
22
|
Cano I, Antón-Pacheco JL, García A, Rothenberg S. Video-assisted thoracoscopic lobectomy in infants☆. Eur J Cardiothorac Surg 2006; 29:997-1000. [PMID: 16716918 DOI: 10.1016/j.ejcts.2005.12.060] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2005] [Revised: 12/12/2005] [Accepted: 12/14/2005] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE Congenital lung malformations are often discovered on routine prenatal sonography or postnatal imaging. Lesions such as congenital cystic adenomatoid malformation or pulmonary sequestration may be asymptomatic at birth, and their management is controversial. Thoracoscopy in children has been mainly used for lung biopsy and for the treatment of empyema and recurrent pneumothorax. Very few reports of more technically demanding procedures, such as lobectomy, are currently available. This report evaluates the safety and efficacy of video-assisted thoracoscopic (VATS) lobectomy in infants and small children with asymptomatic prenatally diagnosed lung lesions. METHODS During 2004, six patients underwent VATS lobectomy without a mini-thoracotomy. Mean age was 10 months (range, 6-19 months). Preoperative diagnosis included congenital cystic adenomatoid malformation (n = 5) and an extralobar pulmonary sequestration. All patients were asymptomatic and surgery was performed electively. Three or four 3-5mm ports were used. Single lung ventilation and controlled low pressure pneumothorax were used in every case. A bipolar sealing device was the preferred mode of vessel ligation and bronchi were closed with interrupted sutures. A chest tube was left in all cases. RESULTS All the procedures were completed thoracoscopically. Operating times ranged from 70 to 215 min (mean, 130 min). There were five lower lobe and one middle lobe resections. There were no intraoperative complications and chest tubes were left in place 1-4 days. Two patients showed postoperative hemothorax that stopped spontaneously. Hospital stay ranged from 4 to 9 days (mean, 7 days). CONCLUSIONS VATS lobectomy in small infants is a feasible and safe technique. Decreased postoperative pain, a shorter hospital stay, and a better cosmetic result are definite advantages of this minimally invasive procedure. Long-term morbidity due to a major thoracotomy incision is avoided.
Collapse
Affiliation(s)
- Indalecio Cano
- Division of Pediatric Surgery and Pediatric Airway Unit, University Hospital 12 de Octubre, Madrid, Spain.
| | | | | | | |
Collapse
|
23
|
Antón-Pacheco JL, Cano I, Comas J, Galletti L, Polo L, García A, López M, Cabezalí D. Management of congenital tracheal stenosis in infancy. Eur J Cardiothorac Surg 2006; 29:991-6. [PMID: 16675228 DOI: 10.1016/j.ejcts.2005.12.061] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2005] [Revised: 12/12/2005] [Accepted: 12/14/2005] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Congenital tracheal stenosis (CTS) is a very infrequent malformation. Till recently, the outlook for these patients was dismal because medical management was the only way of treatment. Surgical and endoscopical techniques developed in the last years have improved the prognosis. We review the short- and long-term outcomes of a single institution experience in the management of children with CTS, comparing different treatment modalities. METHODS Between 1991 and 2004, 19 cases of CTS have been managed in our Unit. Respiratory symptoms varied from mild stridor on exertion to severe distress. Bronchoscopy was performed for diagnostic purposes in all cases; other imaging techniques (computed tomography (CT), magnetic resonance imaging (MRI), bronchography, angiography, doppler-ultrasound) were performed on an individual basis. According to clinical and endoscopical features, patients were classified into three groups. The following data have been studied in each case: sex, age at diagnosis and treatment, anatomical type, associated anomalies, treatment modality, complications, outcome and time of follow-up. RESULTS Ten boys and nine girls have been included in this study. Age at diagnosis ranged from 3 days to 7 years (median, 4 months) and 84% of cases showed associated anomalies. Five patients presented mild or no symptoms and have been managed expectantly. The other 14 cases were operated on because of persistent or severe clinical symptoms. The following procedures were performed: slide tracheoplasty (n = 7), costal cartilage tracheoplasty (n = 5), tracheal resection and reconstruction (n = 3), endoscopical dilatation (n = 3), stent placement (n = 1), and laser resection (n = 1). Three patients required two or more procedures and surgical survival rate is 78%. Overall mortality in the series is 21% and all survivors (15 patients) are asymptomatic or show mild symptoms with respiratory infections only. Follow-up is complete, ranging from 8 months to 12.3 years (mean, 5 years). CONCLUSIONS Bronchoscopy is our preferred diagnostic tool. Selection of the type of treatment depends on the patient's clinical status and the anatomical pattern of the stenosis. In symptomatic cases with short-segment stenosis (<30% of total tracheal length), we prefer tracheal resection with end-to-end anastomosis; for long-segment stenosis (>30%), slide tracheoplasty is our procedure of choice.
Collapse
Affiliation(s)
- Juan L Antón-Pacheco
- Division of Pediatric Surgery and Pediatric Airway Unit, Pediatric Institute of the Heart, University Hospital 12 de Octubre, Madrid, Spain.
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Antón-Pacheco JL, Cano I, García A, López M, Cabezalí D, Martínez A. [Management of congenital tracheomalacia: a single institution experience]. Cir Pediatr 2006; 19:55-60. [PMID: 16846124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
INTRODUCTION Congenital tracheomalacia (CTM) is a rare disease causing tracheal wall collapse when breathing. Herein, we show our experience in the management of this type of airway anomaly, settling the indications for surgical or endoscopic treatment. PATIENTS AND METHODS We have performed a retrospective study, from 1991 to 2003, of patients with a bronchoscopic diagnosis of CTM or bronchomalacia (BM). We have analyzed the following facts: sex, age, indication of the initial bronchoscopy, ethiology, clinical group, anatomic type, associated malformations, treatment modality, complications, results, and time of follow-up. RESULTS 46 patients have been included in this study: 25 boys (54%) and 21 girls (45%). Mean age at diagnosis has been 11 months. The indications for diagnostic bronchoscopy have been: respiratory distress (24%), lung athelectasia (24%), stridor (21%), congenital tracheoesophageal fistula (11%), extubation failure (11%), apneic spells (6%), and recurrent pneumonia (2%). Secondary CTM has been much more frequent (82%) than the primary type (17%). Patients have been classified into 3 groups according to the severity of symptoms: group I--mild symptoms (7 patients); group II---moderate (22); and group III, severe (17). Tracheomalacia was diagnosed in 26 cases (56%), bronchomalacia in 12 (26%) and tracheobronchomalacia in 8 patients (17%). Almost all the patients (95%) have showed other associated malformations. Medical treatment has been instituted in 29 patients (63%), 15 cases (32%) have been managed surgically or endoscopically, and in 2 cases no treatment was tried because of their critical clinical status. In addition, in 17 patients (37%) an antireflux surgical procedure was performed. Satisfactory results have been achieved in 72% of treated patients, fair results were obtained in 4 (9%), and a poor outcome occurred in 2 (4,5%). Another 8 patients have died during follow-up due to unrelated causes. 36 patients (78%) are alive with a mean follow-up period of 5,3 years. CONCLUSIONS Most patients with CTM can he treated conservatively though spontaneous resolution may he expected after the first year of life. Surgical or endoscopical procedures are indicated in those patients with severe respiratory symptoms.
Collapse
Affiliation(s)
- J L Antón-Pacheco
- Unidad de la Vía Aérea y Servicio de Cirugía Pediátrica, Hospital Universitario 12 de Octubre, Madrid.
| | | | | | | | | | | |
Collapse
|
25
|
Abstract
BACKGROUND/PURPOSE Stenosing airway disease, including congenital and acquired lesions, is rare in the pediatric age group. Until recently, the outlook for patients with congenital tracheal stenosis (CTS) was dismal because medical management was the only way of treatment. Surgical and endoscopical techniques developed in the last years have improved the prognosis. This report reviews the short and long-term outcomes of a single-institution experience in the management of CTS in children, comparing different treatment modalities. METHODS From 1991 to 2002, 13 cases of CTS have been managed in the authors unit. Respiratory symptoms varied from mild stridor on exertion to severe distress. Bronchoscopy established the diagnosis in all cases. According to clinical and endoscopical features, patients have been classified into 3 groups. The following data have been studied in each case: sex, age at diagnosis and treatment, anatomic type, associated anomalies, treatment modality, complications, outcome, and time of follow-up. RESULTS Seven girls and 6 boys have been included in this study. Age at diagnosis ranged from 3 days to 7 years (median, 8 months), and 77% showed associated anomalies. Four patients presented mild or no symptoms and have been treated expectantly. The other 9 patients have been operated on because of persistent or severe symptomatology. The following procedures have been performed: costal cartilage tracheoplasty (n = 5), tracheal resection (n = 3), slide tracheoplasty (n = 2), endoscopical dilatation (n = 3), and laser resection (n = 1). Three patients required 2 or more procedures, and there were 3 early deaths, all after costal cartilage tracheoplasty. Overall mortality rate in the series is 23%. Follow-up is complete in all survivors (n = 10) ranging from 6 months to 10 years (mean, 4.7 years). CONCLUSIONS Selection of the type of treatment depends on the patient's clinical status and the anatomic pattern of the stenosis. In symptomatic cases of short-segment stenoses the authors prefer tracheal resection with end-to-end anastomosis; for long-segment stenoses, slide tracheoplasty is the procedure of choice.
Collapse
Affiliation(s)
- Juan L Antón-Pacheco
- Department of Pediatric Surgery and Pediatric Airway Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | | | | | | |
Collapse
|
26
|
Delgado Muñoz MD, Antón-Pacheco JL, Matute JA, Cuadros J, Aguado P, Vivanco JL, Berchi FJ. [Surgery of lung metastasis]. Cir Pediatr 2000; 13:7-10. [PMID: 12602014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
INTRODUCTION The 30-40% of the oncologic patients have pulmonary metastases. Lung can be the only organ affected. In selected patients, exeresis of the pulmonary nodules can mean their healing. MATERIAL AND METHODS Between 1982-1997, twenty two patients presented metastases, 13 could be operated and 16 thoracotomies were done. There were 53% boys and 47% girls whose ages ranged from 3 to 15 years. We have considered: pulmonary tumour location, disease free interval, number of metastases, surgical technique and incomplete pulmonary tumour resection. RESULTS Primary tumours were: Wilms tumours 23%, bone tumours 67% (Ewing and osteosarcoma). Disease free interval was < 2 years in 8 patients (61%) and > 2 years in 39%. X-Ray and CT were performed in every case and 66% presented a solitary nodule. Surgical techniques were: metastasectomy in two cases (12%), wedge resection in 8 (50%) and lobectomy in six cases (38%). We made thoracoscopy in two patients. There weren't postoperatory mortality but the patients with tumorectomy had an incomplete surgical resection. The overall survival is 54 percent and the 5 years survival is 23 percent (3 patients). CONCLUSIONS The patients with a DFI < 2 years have a survival of 25% compared with 100% for patients who have a DFI > 2 years. The pulmonary resection in selected patients can offer better survival. We can use the thoracoscopy in same selected patients.
Collapse
Affiliation(s)
- M D Delgado Muñoz
- Servicio de Cirugía Pediátrica, Hospital Universitario Doce de Octubre, Madrid
| | | | | | | | | | | | | |
Collapse
|