A 10-day-old patient was urgently transferred from another hospital to IASO Children's Hospital with severe respiratory insufficiency secondary to congenital stenosis of the lower trachea. The infant underwent slide plasty, which involves the removal of the narrowed part of the trachea and its reconstruction with the right main-stem bronchus (Figure 1). The procedure was performed by the specialized and experienced team of the IASO Children's Hospital Pediatric Cardiology Department - Congenital Heart Diseases Center, headed by Professor Afksendiyos Kalangos, the cardiac surgeons Dr. Evangelia Dalarizou, Dr. Panagiotis Sfyridis, and Dr. Prodromos Azariadis and was supported by the IASO Children's Hospital Cardiac Intensive Care Unit.
Congenital tracheal stenosis (CTS) is a serious and rare condition which is characterized by a narrowing of the tracheal lumen, most commonly due to complete tracheal cartilage rings, instead of normal semicircular-shaped rings, and an absent membranous trachea.
The severity of symptoms depends on the length of the stenosis, the presence of concomitant respiratory conditions, the degree of luminal narrowing, and any bronchial involvement. Imagine running a 100-meter sprint and then trying to breathe through a straw. For children suffering from long segment tracheal stenosis, this is what trying to breathe normally can feel like.
This is an anomaly that can cause severe respiratory insufficiency, especially in neonates and infants, and ultimately lead to death. Therefore, it is a clinical condition that requires prompt diagnosis and management. It is also important and necessary for a group of health professionals, including pediatric anesthesiologists, pediatric pulmonologists, pediatric otolaryngoligists (ENT), pediatric cardiologists and pediatric critical care physicians to team up for the effective treatment of the disease.
It is worth noting that Professor Kalangos and his team, performed the country’s first ever sliding plasty in combination with the surgical repair of a vascular ring in an 18-month-old patient suffering from congenital tracheal stenosis complicated with congenital heart disease (pulmonary sling) (Figure 2). An 18-month-old infant with Klinefelter Syndrome and dyspnea for one week arrived from another hospital in order for the dyspnea to be investigated. During the ENT assessment, tracheal stenosis was diagnosed and the patient was admitted to the Intensive Care Unit where he was intubated. Ultrasound verified the presence of congenital heart disease (pulmonary sling). The computed tomography angiography revealed long segment tracheal stenosis (with complete rings) and the presence of a vascular ring (pulmonary sling).