Slide Tracheoplasty on Cardiopulmonary Bypass

The patient was a 2-year-old girl with VACTERL syndrome. The patient had been adopted from China at two years of age. In China, she underwent unknown procedures to repair her spina bifida and imperforate anus. The patient also had butterfly vertebrae, renal anomalies, bilateral club feet, and tethered cord. Following adoption, the patient underwent bilateral Achilles tendon release and laminectomy.

The patient had a baseline cough since birth, however she developed viral respiratory symptoms which eventually prompted a CT scan. CT scan identified a large tracheal bronchus to her right upper lobe (bronchus suis) with a very small distal trachea with complete tracheal rings. Her proximal main bronchi appeared small, however they appeared to open to normal size distally.

During this workup, a murmur was also auscultated. A transthoracic echocardiogram revealed a small, discrete subaortic membrane with a peak systolic gradient of 16 mm Hg with mild aortic insufficiency.

The patient was presented at a case management conference with the consensus being that there was no indication for cardiac repair at this time, however the tracheal stenosis needed to be addressed. Due to the location of the stenosis, the decision was made to perform this through a sternotomy on cardiopulmonary bypass.

The patient had an uneventful postoperative course and was discharged on postoperative day 11.

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