Congenital Tracheal Stenosis

Seoul National University Hospital

Department of Thoracic & Cardiovascular Surgery

Congenital Tracheal Stenosis

1. Type (Cantrell & Guild, 1964)

Generalized hypoplasia

Funnel-like stenosis

Segmental stenosis

2. Tracheal origin of Rt. upper lobe ; 20%

3, Associated heart defect in long stenosis

PA sling ; 25%

Intracardiac defect ; 20%

Tracheal Reconstruction

1. Pericardial tracheoplasty

2. Cartilage tracheoplasty

3. Slide tracheoplasty

4. Resection & end-to-end anastomosis

5. Tracheal homograft & autograft

History of Tracheoplasty

Pericarial tracheoplasty ; Idriss et al. 1984

Sliding tracheoplasty ; Tsang et al. 1989

Modified sliding tracheoplasty ; Grillo, 1994

Metallic stent in bronchus ; Wallace ,1986

1. Too repeated endoscopic excision

2. Lumen obstruction

3. Graft rupture

4. Recurrence of stenosis

Rejection of graft

Growth failure

Complication of EnlargementTracheoplasty

Complications of Stent

1. Migration

2. Fracture of metallic mesh

3. Granulation tissue

4. Ingrowth of tumor, mucosal hyperplasia

5. Blockage

6. Erosion into adjacent tissue

7. Infolding of coated membrane-plugging of secretion

Tracheobronchial Stent

1) Nitinol ( SENS; nickel-titanium, 0.15mm nitinol wire, Elastalloy )

2) Dynamic stent

Covered : Biobrane ( biosynthetic skin substitute )

Polyurethran

Silicone

3) Gianturco ; expendable preset memory (covered or not)

4) Palmaz ; balloon dilatation fixed stent

5) Vinograd ; nickel-titanium alloy with preset memory of 37 degree

6) Bioabsorbable stent; self reinforced poly-L-lactide 0.7 mm spiral

7) Polyester filament 0.45 mm self expandable stent coated with

silicone(TREVIRA)

8) Silicone stent ; drawbacks are thick wall & rigid