Tracheal growth after slide tracheoplasty

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Presentation transcript:

Tracheal growth after slide tracheoplasty Paolo Macchiarini, MDa, Elisabeth Dulmet, MDb, Vincent de Montpreville, MDb, Guy-Michel Mazmanian, MDc, Alain Chapelier, MDa, Philippe Dartevelle, MDa The Journal of Thoracic and Cardiovascular Surgery Volume 113, Issue 3, Pages 558-566 (March 1997) DOI: 10.1016/S0022-5223(97)70371-4 Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 1 Technique of slide tracheoplasty. A, After exposure of the cervical trachea (CT) from the second cartilaginous ring above to the right upper lobe takeoff below, the airway was transected at its midportion and one to two tracheal rings were excised. Two vertical incisions of approximately 2.5 cm each were then made on the posterior wall of the upper segment first and on the anterior wall of the lower segment next. B, The right-angled corners of the two divisions were then trimmered and C, then reconstructed together. The overall length of the cervical tracheas was 6.04 ± 0.5 cm (approximately four rings per centimeter of length). The Journal of Thoracic and Cardiovascular Surgery 1997 113, 558-566DOI: (10.1016/S0022-5223(97)70371-4) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 2 A, Tracheal specimens after removal of a 1 mm thick PTFE patch used to infold the membranous tracheas. B, As a consequence of the membranous infolding, all stenotic tracheas had complete tracheal rings with peritracheal fibrosis (arrow) but without acute inflammatory reaction of the tracheal mucosa. This picture is that usually seen in neonates who have noncomplicated long congenital tracheal stenosis with complete tracheal ring. (Toluidine blue and hematoxylin; original magnification ×10.) The Journal of Thoracic and Cardiovascular Surgery 1997 113, 558-566DOI: (10.1016/S0022-5223(97)70371-4) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 2 A, Tracheal specimens after removal of a 1 mm thick PTFE patch used to infold the membranous tracheas. B, As a consequence of the membranous infolding, all stenotic tracheas had complete tracheal rings with peritracheal fibrosis (arrow) but without acute inflammatory reaction of the tracheal mucosa. This picture is that usually seen in neonates who have noncomplicated long congenital tracheal stenosis with complete tracheal ring. (Toluidine blue and hematoxylin; original magnification ×10.) The Journal of Thoracic and Cardiovascular Surgery 1997 113, 558-566DOI: (10.1016/S0022-5223(97)70371-4) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 3 The reconstructed trachea lengthens constantly (6.4 ± 1.75 to 11.5 ± 0.74 cm) and linearly (p < 0.0001) over a sixfold increase in age in all piglets (n = 12). The reconstructed trachea was arbitrarily called the cervical trachea and extended from the second cartilaginous ring above to the right upper lobe takeoff below. The Journal of Thoracic and Cardiovascular Surgery 1997 113, 558-566DOI: (10.1016/S0022-5223(97)70371-4) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 4 There was no differential (p = not significant) growth of the reconstructed trachea between pigs belonging to groups 1 (closed circles) and 2 (open circle), and the relation between tracheal length and body weight was significant in both groups (p < 0.0001). The final lengths of the postmortem cervical tracheas were 8.5 ± 2.1 cm and 9.26 ± 1.6 for pigs belonging to groups 1 and 2, respectively (p > 0.2). The reconstructed trachea was arbitrarily called the cervical trachea and extended from the second ring above to the right upper lobe takeoff below. The Journal of Thoracic and Cardiovascular Surgery 1997 113, 558-566DOI: (10.1016/S0022-5223(97)70371-4) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 5 The cross-sectional area (CSA) of the anastomotic (closed circles) and normal (open circles) tracheas increased linearly (p < 0.0001) at a rate of 1.60 mm2/kg and 1.51 mm2/kg, respectively, as body weight increased. The Journal of Thoracic and Cardiovascular Surgery 1997 113, 558-566DOI: (10.1016/S0022-5223(97)70371-4) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 6 Ratio of the cross-sectional area of the anastomotic (CSAA) to normal (CSAN) cervical trachea over the period study. It was not different between the two groups (p > 0.2). The CSAA and CSAN enlarged from 51.8 ± 31.8 to 170.6 ± 25.1 mm2 and from 15.8 ± 14.8 to 109.5 ± 18.5 mm2, respectively. Error bars represent the standard deviation. The Journal of Thoracic and Cardiovascular Surgery 1997 113, 558-566DOI: (10.1016/S0022-5223(97)70371-4) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 7 Micrograph of the anastomotic (A) and normal (B) trachea taken when the animal was put to death. A, The anastomotic tracheas assumed a more ovoid shape but displayed a normal respiratory epithelium even at the overlapping of the two spatulated tracheal tongues (arrowhead); note the absence of granulation tissue. B, By contrast, the nonanastomotic tracheas were circular. In this specimen, the anastomotic cross-sectional area was 1.88 larger than that of the normal trachea. (Toluidine blue and hematoxylin; original magnification ×10.) The Journal of Thoracic and Cardiovascular Surgery 1997 113, 558-566DOI: (10.1016/S0022-5223(97)70371-4) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 7 Micrograph of the anastomotic (A) and normal (B) trachea taken when the animal was put to death. A, The anastomotic tracheas assumed a more ovoid shape but displayed a normal respiratory epithelium even at the overlapping of the two spatulated tracheal tongues (arrowhead); note the absence of granulation tissue. B, By contrast, the nonanastomotic tracheas were circular. In this specimen, the anastomotic cross-sectional area was 1.88 larger than that of the normal trachea. (Toluidine blue and hematoxylin; original magnification ×10.) The Journal of Thoracic and Cardiovascular Surgery 1997 113, 558-566DOI: (10.1016/S0022-5223(97)70371-4) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 8 A, Contractile response of the anastomotic (closed circles) and neighboring normal (open circles) tracheal smooth muscles to increasing doses of carbachol. The maximal response (Emax) and concentration of agonist yielding 50% of maximal response (EC50) of the anastomotic smooth muscles were 5340 ± 600 mg and 7.31 E-7 ± 0.5 mol/L, respectively; by contrast, the Emax and EC50 of the normal smooth muscles were 8540 ± 880 mg and EC50 of 9.33 E-7 ± 1.28 mol/L, respectively (p < 0.001). B, Relaxation response of the anastomotic (closed circles) and neighboring normal (open circles) tracheal smooth muscles to isoproterenol (precontracted with carbachol). The Emax and EC50 were, respectively, 85% ± 3% and 8.28 E-7 ± 0.85 mol/L for the anastomotic and 83% ± 6% and 8.28 E-7.58 ± 0.2 mol/L for the normal smooth muscles (p > 0.2). Error bars represent the standard deviation. The Journal of Thoracic and Cardiovascular Surgery 1997 113, 558-566DOI: (10.1016/S0022-5223(97)70371-4) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 8 A, Contractile response of the anastomotic (closed circles) and neighboring normal (open circles) tracheal smooth muscles to increasing doses of carbachol. The maximal response (Emax) and concentration of agonist yielding 50% of maximal response (EC50) of the anastomotic smooth muscles were 5340 ± 600 mg and 7.31 E-7 ± 0.5 mol/L, respectively; by contrast, the Emax and EC50 of the normal smooth muscles were 8540 ± 880 mg and EC50 of 9.33 E-7 ± 1.28 mol/L, respectively (p < 0.001). B, Relaxation response of the anastomotic (closed circles) and neighboring normal (open circles) tracheal smooth muscles to isoproterenol (precontracted with carbachol). The Emax and EC50 were, respectively, 85% ± 3% and 8.28 E-7 ± 0.85 mol/L for the anastomotic and 83% ± 6% and 8.28 E-7.58 ± 0.2 mol/L for the normal smooth muscles (p > 0.2). Error bars represent the standard deviation. The Journal of Thoracic and Cardiovascular Surgery 1997 113, 558-566DOI: (10.1016/S0022-5223(97)70371-4) Copyright © 1997 Mosby, Inc. Terms and Conditions