Congenital Tracheal Stenosis Seoul National University Hospital Department of Thoracic & Cardiovascular Surgery.

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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 Sliding tracheoplasty ; Tsang et al 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 Enlargement Tracheoplasty

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