Case ReportAn approach to successful slide tracheoplasty in the low birth weight neonate with single lung
Introduction
The advent of the slide tracheoplasty technique and a multi-disciplinary approach has improved outcomes of tracheal stenosis [[1], [2], [3]]. Despite these improvements, tracheal surgery in low birth-weight neonates has been associated with increased mortality [3]. Furthermore, patients with concomitant pulmonary malformations have a higher mortality after slide tracheoplasty [4]. We report a successful approach of delaying tracheal reconstruction to allow growth and development in the premature, very low birth-weight neonate with left lung agenesis.
Section snippets
Case report
A 15 day-old neonate born at 29-weeks gestation (1046g) with the antenatal diagnosis of left lung agenesis was transferred to our institution. At the time of intubation for respiratory failure, the endotracheal tube could not be advanced beyond mid-trachea. Computerized tomography scan (Fig. 1) confirmed the diagnosis of mid tracheal long-segmental (40%) narrowing with multiple focal stenosis and left lung agenesis. The tip of endotracheal tube was at C6 vertebra level. The first area of
Discussion
Surgery is recommended once diagnosis is made in symptomatic patients with tracheal stenosis that cannot be weaned off from mechanical ventilation. However, these patients are in a critical state, often have low birth-weights and associated congenital cardiac defects. Hence operative intervention, even with the benefits of the slide tracheoplasty technique, poses technical challenges and is associated with a significant risk of death [3]. The use of balloon tracheoplasty in low birth-weight
Conclusion
Delaying tracheal reconstruction is a viable approach in the high-risk neonate with tracheal stenosis, very low birth weight and lung agenesis.
Disclosures
Dr Yong is supported by the David B. Rosenthal Scholarship (University of Melbourne), Australian Government Research Training Program Scholarship and NHMRC Postgraduate Scholarship (APP1133977).
Conflicts of interest
None.
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