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Oldakovskiy V, Murashkin N, Lokhmatov M, Gusev A, Tupylenko A, Budkina T, Yatzik S, Dyakonova E, Abaykhanov R, Fisenko A. Our experience of using Losartan for esophageal stenosis in children with dystrophic form of congenital epidermolysis bullosa. J Pediatr Surg 2023; 58:619-623. [PMID: 36566169 DOI: 10.1016/j.jpedsurg.2022.11.001] [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: 10/11/2022] [Accepted: 11/03/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Dystrophic epidermolysis bullosa (DEB) is one of the most severe forms of congenital epidermolysis bullosa and characterized by the formation of many surgical complications. Esophageal stenosis is a common complication of DEB and occurs in almost 76% of cases. Balloon dilatation (BD) under X-ray control is the main therapeutic technique, however conservative treatment is necessary to prevent restenosis. The use of the drug losartan is promising due to its antifibrotic effect through the suppression of transforming growth factor-β1 (TGF-β1). PURPOSE To evaluate the efficacy of losartan in the prevention of restenosis after BD of esophageal stenosis in children with DEB. MATERIALS AND METHODS The study included 19 children from 2 to 16 years old (mean age 9.2 ± 3.58 years) with DEB and X-ray confirmed esophageal stenosis. All children underwent BD. In the main group 9 children after BD have received losartan, in the control group of 10 children - only standard therapy. The observation period was 12 months. RESULTS In the main group, 1 child (11.1%) required repeated dilatation, in the control group - 4 children (40%). Indicators of nutritional deficiency (THINC scale) and the disease severity index (EBDASI) were significantly lower in the group of children treated with losartan. No undesirable actions of the drug were recorded. CONCLUSIONS In this study losartan showed its safety, contributed to a decrease in the restenosis frequency and an improvement in the nutritional status of children with DEB after BD. However, further studies are required to confirm its effectiveness. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Vladislav Oldakovskiy
- The National Medical Research Center of Children's Health, Lomonosovskiy prospect, 2/1, 119991, Moscow, Russia
| | - Nikolay Murashkin
- The National Medical Research Center of Children's Health, Lomonosovskiy prospect, 2/1, 119991, Moscow, Russia
| | - Maksim Lokhmatov
- The National Medical Research Center of Children's Health, Lomonosovskiy prospect, 2/1, 119991, Moscow, Russia
| | - Aleksey Gusev
- The National Medical Research Center of Children's Health, Lomonosovskiy prospect, 2/1, 119991, Moscow, Russia; Peoples' Friendship University of Russia (RUDN University), Miklukho-Maklaya str. 6, 117198, Moscow, Russia.
| | - Artem Tupylenko
- The National Medical Research Center of Children's Health, Lomonosovskiy prospect, 2/1, 119991, Moscow, Russia
| | - Tatiana Budkina
- The National Medical Research Center of Children's Health, Lomonosovskiy prospect, 2/1, 119991, Moscow, Russia
| | - Sergey Yatzik
- The National Medical Research Center of Children's Health, Lomonosovskiy prospect, 2/1, 119991, Moscow, Russia
| | - Elena Dyakonova
- The National Medical Research Center of Children's Health, Lomonosovskiy prospect, 2/1, 119991, Moscow, Russia
| | - Rasul Abaykhanov
- The National Medical Research Center of Children's Health, Lomonosovskiy prospect, 2/1, 119991, Moscow, Russia
| | - Andrey Fisenko
- The National Medical Research Center of Children's Health, Lomonosovskiy prospect, 2/1, 119991, Moscow, Russia
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Alkhasov A, Ratnikov S, Lezhnev A, Razumovskiy A, Sergeeva I, Kuzin S, Komina E, Gusev A, Yatzik S, Romanova E, Savelieva M, Fisenko A. Sliding tracheoplasty of complete tracheal cartilage rings in children. J Pediatr Surg 2023; 58:624-628. [PMID: 36653203 DOI: 10.1016/j.jpedsurg.2022.12.022] [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: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Complete tracheal rings are a rare malformation that occurs in 1 out of 100,000 live births. It is rare, isolated tracheal or tracheobronchial anomaly developed due to abnormal cartilage growth with formation of complete ring and often resulting in airway stenosis. Slide tracheoplasty, as it was originally described by Tsang et al. and popularized by Grillo et al., overlaps stenotic segments of trachea, shortening trachea itself, thus, doubling the circumference and diameter of the stenotic area. MATERIALS AND METHODS We have performed slide tracheoplasty in 12 children during the period of 2019-2021 in thoracic surgery department of our center. Median age was 15 ± 21,1 months (2 months-6 years),median weight - 8,04 ± 4,75 kg (3-20,7 kg),tracheal lumen varied from 2.5 to 3.0 mm, stenosis length - from 40 to 70% of the trachea length. RESULTS Slide tracheoplasty was performed using central veno-arterial extracorporeal membrane oxygenation in 7 cases and using cardiopulmonary bypass in 5 cases. Concomitant heart disease was revealed in 5 children (pulmonary artery sling in 3 cases, ventricular septal defects - 1, aberrant subclavian artery -1). 5 children underwent one-stage correction of VSD: plastic VSD -1; left pulmonary artery reimplantation - 3; subclavian artery reimplantation - 1. All patients were on mechanical ventilation for 4,3 ± 2,78 days at postoperative period. Patients were discharged 16,3 ± 5,14 days after surgery. Satisfactory result of treatment in the form of respiratory failure relief was achieved in 10 patients. It was possible to increase the trachea lumen from 1.5 to 2 times in all cases. There were 2 (16,6%) fatal cases due to sepsis and multi-organ failure development. CONCLUSIONS Children with complete tracheal rings are very complicated patients with various comorbidities. Despite the advances in medicine, sometimes it is impossible to save lives of these children. The use of extracorporeal circulation (ECMO and bypass) allows us to safely perform reconstructive surgery on the trachea and save the child from respiratory failure manifestations. If needed, simultaneous correction of heart and tracheal defects is possible. Slide tracheoplasty allows to increase trachea lumen at least in 1.5-2 times. Mechanical ventilation is an unfavorable predictive factor for the outcomes of congenital tracheal stenosis management. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Abdumanap Alkhasov
- The National Medical Research Center of Children's Health, Lomonosovskiy Prospect, 2/1, Moscow, 119991, Russia
| | - Sergey Ratnikov
- The National Medical Research Center of Children's Health, Lomonosovskiy Prospect, 2/1, Moscow, 119991, Russia
| | - Alexandr Lezhnev
- The National Medical Research Center of Children's Health, Lomonosovskiy Prospect, 2/1, Moscow, 119991, Russia
| | - Aleksandr Razumovskiy
- State Budgetary Educational Institution of Higher Professional Education, Russian National Research Medical University Named After N.I. Pirogov, Ministry of Health of Russia, Moscow, Russia
| | - Irina Sergeeva
- The National Medical Research Center of Children's Health, Lomonosovskiy Prospect, 2/1, Moscow, 119991, Russia
| | - Sergey Kuzin
- The National Medical Research Center of Children's Health, Lomonosovskiy Prospect, 2/1, Moscow, 119991, Russia
| | - Elena Komina
- The National Medical Research Center of Children's Health, Lomonosovskiy Prospect, 2/1, Moscow, 119991, Russia
| | - Aleksey Gusev
- The National Medical Research Center of Children's Health, Lomonosovskiy Prospect, 2/1, Moscow, 119991, Russia; Peoples' Friendship University of Russia (RUDN University), Miklukho-Maklaya Str. 6, Moscow, 117198, Russia.
| | - Sergey Yatzik
- The National Medical Research Center of Children's Health, Lomonosovskiy Prospect, 2/1, Moscow, 119991, Russia
| | - Ekaterina Romanova
- The National Medical Research Center of Children's Health, Lomonosovskiy Prospect, 2/1, Moscow, 119991, Russia
| | - Maria Savelieva
- The National Medical Research Center of Children's Health, Lomonosovskiy Prospect, 2/1, Moscow, 119991, Russia
| | - Andrey Fisenko
- The National Medical Research Center of Children's Health, Lomonosovskiy Prospect, 2/1, Moscow, 119991, Russia
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Alkhasov A, Razumovsky A, Gusev A, Tepaev R, Ratnikov S, Lezhnev A, Romanova E, Komina E, Saveleva M, Dyakonova E, Yatzik S. Surgical Treatment of Patients with Full Tracheal Rings: Our Experience. J Laparoendosc Adv Surg Tech A 2021; 31:1511-1515. [PMID: 34847727 DOI: 10.1089/lap.2021.0337] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Complete tracheal rings are a rare pathology occurring in 1 out of 100,000 live births. It is rare isolated tracheal or tracheobronchial anomaly resulting from abnormal cartilage growth, forming a complete ring, and leading to airway stenosis. A sliding tracheoplasty, primarily described by Tsang et al. and later widely presented by Grillo et al., overlaps the tracheal stenosing segments and shortens the trachea itself, and thus increases the diameter and circumference of the stenosing area double up. Materials and Methods: We have performed four slide tracheoplasties in the period between February 2019 and December 2020 in children who underwent medical treatment in the department of thoracic surgery in our center. Median age was 10 ± 5.5 months (2 months-1 year 6 months). Median weight was 6.9 ± 1.9 kg (4.5-9 kg). Slide tracheoplasty was performed using central venoarterial extracorporeal membrane oxygenation in 3 cases and using cardiopulmonary bypass in 1 case. Results: Patients were on artificial lung ventilation for 2-6 days in the postoperative period. Patients were discharged 14-18 days after the surgery. There were no lethal outcomes in our study. Discussion: Long segment congenital tracheal stenosis is an often and serious life-threatening anatomical malformation that bounded the length of trachea >50%. There is no unique treatment strategy for patients with such pathology. Sliding tracheoplasty can be recommended for all, but not for the shortest segments of stenosis, as it creates permissible voltage fluctuations during tracheal anastomosis. Excellent results in management of such severe patients can be achieved only through the collaboration of multidisciplinary team of specialists sharing organized and consistent patient-oriented approach.
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Affiliation(s)
- Abdumanap Alkhasov
- Federal State Autonomous Institution "National Medical Research Center of Children's Health" Of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Alexander Razumovsky
- State Budgetary Educational Institution of Higher Professional Education "Russian National Research Medical University named after N.I. Pirogov" Ministry of Health of Russia, Moscow, Russian Federation
| | - Alexey Gusev
- Federal State Autonomous Institution "National Medical Research Center of Children's Health" Of the Ministry of Health of the Russian Federation, Moscow, Russian Federation.,RUDN University (Peoples' Friendship University of Russia), Moscow, Russian Federation
| | - Rustem Tepaev
- Federal State Autonomous Institution "National Medical Research Center of Children's Health" Of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Sergey Ratnikov
- Federal State Autonomous Institution "National Medical Research Center of Children's Health" Of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Alexandr Lezhnev
- Federal State Autonomous Institution "National Medical Research Center of Children's Health" Of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Ekaterina Romanova
- Federal State Autonomous Institution "National Medical Research Center of Children's Health" Of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Elena Komina
- Federal State Autonomous Institution "National Medical Research Center of Children's Health" Of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Maria Saveleva
- Federal State Autonomous Institution "National Medical Research Center of Children's Health" Of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Elena Dyakonova
- Federal State Autonomous Institution "National Medical Research Center of Children's Health" Of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Sergey Yatzik
- Federal State Autonomous Institution "National Medical Research Center of Children's Health" Of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
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