Managing Congenital Heart Disease in Children with Airway Anomalies

A new study evaluated treatment approaches for pediatric patients who face the complex condition of having both congenital heart diseases (CHD) and airway anomalies.

In this retrospective study, patients diagnosed with CHD and airway anomalies were recruited from the Pediatric Cardiac Surgery Centre of Fuwai Hospital from 2016 to 2020. Patients were categorized into three groups based on the different management approaches they received – the conservative group, the slide group (involving slide tracheoplasty), and the suspension group (involving suspension with external stenting). 

Overall, 139 patients were selected, with 107 undergoing conservative airway treatment (conservative group), 15 undergoing slide tracheoplasty (slide group), and 17 undergoing tracheal suspension operations (suspension group). It was found that ventricular septal defect (N=34, 24%), pulmonary artery sling (N=22, 16%), and tetralogy of Fallot (N=15, 11%) were the most commonly associated intracardiac anomalies. In comparison to patients who received conservative airway management (with a median duration of 100 minutes and an interquartile range of 62-152), the additional airway procedures led to an extended duration of cardiopulmonary bypass (CPB) – with a median of 202 minutes for the slide group (IQR, 119-220) and 150 minutes for the suspension group (IQR, 125-161). Patients who underwent slide tracheoplasty required prolonged mechanical ventilation, with a median duration of 129 minutes and an interquartile range of 56-328. There were six in-hospital deaths, all of which occurred in the conservative group; eight mid- to long-term fatalities were reported – with six in the conservative group.

This study revealed that both conservative and surgical management approaches for patients with CHD and airway anomalies yield promising outcomes. However, including extra tracheobronchial procedures, particularly slide tracheoplasty, significantly extends the duration of cardiopulmonary bypass. The findings underscore the importance of developing individualized management strategies for patients with CHD and airway anomalies through multi-disciplinary team assessment.

Source: Liu Y, He Q, Dou Z, Ma K, Chen W, Li S. The Journal of Pediatrics. 2023 Sep 17:113741.