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Journal of Veterinary Internal Medicine 2023Principal and lobar bronchial collapse is increasingly recognized as an isolated entity.
BACKGROUND
Principal and lobar bronchial collapse is increasingly recognized as an isolated entity.
OBJECTIVE
Retrospectively describe the procedure and outcomes of dogs undergoing bronchial stenting at a single referral hospital.
ANIMALS
Nine client-owned dogs with variable degrees of collapse of the left principal bronchus (LPB), lobar bronchus 1 (LB1), and lobar bronchus 2 (LB2), and with clinically relevant signs of respiratory dysfunction.
METHODS
Data were collected from patient records. All dogs underwent stenting of the LPB and LB2. Anatomic and functional impairment grades were assigned to each case before and 4 weeks after stenting. Data regarding response to stenting and complications were evaluated.
RESULTS
Bronchial stenting was considered successful in all cases, with all dogs experiencing improved quality of life (QOL), and decreased functional impairment grade at 4 weeks post-stenting. Follow-up of >6 months was available for 6 dogs and of these, 5 were alive at 12 months, 3 were alive at 18 months, and 1 was alive at 24 months. Stent-related complications occurred in 4 dogs, and were resolvable in 3. Two dogs developed pneumothorax, 1 developed recurrent pneumonia, and 1 developed new-onset coughing. All dogs had mild and manageable coughing post-stenting.
CONCLUSIONS AND CLINICAL IMPORTANCE
Stenting of the LBP and LB2 might be an effective option for dogs with advanced collapse of these bronchi and associated signs. Although all included dogs had resolution or improvement of clinical signs considered life-threatening or as affecting QOL, ongoing coughing is expected. Patient selection appears important with regard to achieving successful outcomes.
Topics: Humans; Dogs; Animals; Quality of Life; Retrospective Studies; Bronchi; Trachea; Stents; Dog Diseases
PubMed: 37695258
DOI: 10.1111/jvim.16859 -
The Veterinary Quarterly Dec 2023Dynamic lower airway obstruction is the primary component of canine bronchomalacia, but the ventilatory function remains underinvestigated. This prospective study...
Dynamic lower airway obstruction is the primary component of canine bronchomalacia, but the ventilatory function remains underinvestigated. This prospective study analyzed tidal breathing characteristics in 28 dogs, comprising 14 with severe bronchomalacia diagnosed by bronchoscopy versus 14 without respiratory disease. Spirometry was conducted in all dogs. Bronchoscopy with bronchoalveolar lavage or brush under anesthesia was performed in 14 dogs with cough and expiratory effort. Severe bronchomalacia was defined by the severity of collapse and total number of bronchi affected. Ventilatory characteristics were compared between groups. Results revealed that dogs with severe bronchomalacia had lower minute volume (218 vs 338 mL/kg, = .039) and greater expiratory-to-inspiratory time ratio (1.55 vs 1.35, = .01) compared to control dogs. The tidal breathing pattern of dogs with bronchomalacia was different from that of normal dogs, and the pattern differed from the concave or flat expiratory curves typical of lower airway obstruction. Compared to control dogs, dogs with severe bronchomalacia had a significantly prolonged low-flow expiratory phase ( < .001) on the flow-time plot and a more exponential shape of the expiratory curve ( < .001) on the volume-time plot. Flow-time index ExpLF/Te (>0.14) and volume-time index Vt-AUCexp (≤31%) had a high ROC-AUC (1.00, 95% confidence interval 0.88 to 1.00) in predicting severe bronchomalacia. In conclusion, the tidal breathing pattern identified here indicates abnormal and complicated ventilatory mechanics in dogs with severe bronchomalacia. The role of this pulmonary functional phenotype should be investigated for disease progression and therapeutic monitoring in canine bronchomalacia.
Topics: Dogs; Animals; Bronchomalacia; Bronchoscopy; Prospective Studies; Respiration; Airway Obstruction; Phenotype; Dog Diseases
PubMed: 37616027
DOI: 10.1080/01652176.2023.2252518 -
Children (Basel, Switzerland) Feb 2024Down Syndrome (DS) is the most common chromosomal abnormality compatible with life. The life of patients suffering from DS can be strongly impacted by Recurrent... (Review)
Review
Down Syndrome (DS) is the most common chromosomal abnormality compatible with life. The life of patients suffering from DS can be strongly impacted by Recurrent Respiratory tract Infections (RRIs), leading to an increased rate of hospitalisation, a higher need for intensive care and fatality. With a literature review, we summarise here the main etiological factors for RRI in this category of patients, particularly focusing on airway malformations such as tracheomalacia, tracheal bronchus and bronchomalacia, comorbidities associated with the syndrome, like congenital heart diseases, dysphagia, gastroesophageal reflux, musculoskeletal involvement and obesity, and immunologic impairments, involving both innate and adaptive immunity. For these patients, a multidisciplinary approach is imperative as well as some preventive strategies, in particular vaccinations in accordance with their national schedule for immunization.
PubMed: 38397357
DOI: 10.3390/children11020246 -
Cureus Oct 2023Tracheal stenosis can occur from several malignant and non-malignant conditions, including vascular ring/aneurysms, tracheomalacia, bronchomalacia, endotracheal tubes...
Tracheal stenosis can occur from several malignant and non-malignant conditions, including vascular ring/aneurysms, tracheomalacia, bronchomalacia, endotracheal tubes (ETT), tracheostomy tubes, mucus plug, burn, trauma, tuberculosis, etc. Significant tracheal stenosis typically requires management by bronchoscopy, dilatation, or surgical resection. Bronchoscopic balloon dilatation is a simple, inexpensive, safe, and minimally invasive method that can be used to dilate airway stenosis and restore adequate airflow. A Montgomery tracheostomy tube is often used as a combined tracheal stent and airway device. We describe a 68-year-old female with tracheal stenosis, which was managed with an unconventional approach, a non-compliant endovascular balloon, due to resource scarcity.
PubMed: 38021857
DOI: 10.7759/cureus.47496 -
ATS Scholar Mar 2024Although hands-on simulation plays a valuable role in procedural training, there are limited tools available to teach pediatric flexible bronchoscopy (PFB). Fellowship...
BACKGROUND
Although hands-on simulation plays a valuable role in procedural training, there are limited tools available to teach pediatric flexible bronchoscopy (PFB). Fellowship programs rely on patient encounters, with inherent risk, or high-cost virtual reality simulators that may not be widely available and create education inequalities.
OBJECTIVE
Our objective was to study the educational value and transferability of a novel, low-cost, three-dimensional-printed pediatric airway model (3D-AM) for PFB training. Our central hypothesis was that the 3D-AM would have high educational value and would be easily transferrable to learners at different teaching hospitals.
METHODS
The 3D-AM was designed to teach technical bronchoscopy skills, airway anatomy, airway pathology, and bronchoalveolar lavage (BAL). The curriculum was offered to incoming fellows in pediatric pulmonology, pediatric surgery, and pediatric critical care across three different teaching institutions. After course completion, each participant assessed the simulation model(s) with a 5-point Likert scale across six domains: physical attributes, realism of experience, ability to perform tasks, value, relevance, and global impression. The expert instructors assessed the learners' competency using a modified version of the Bronchoscopy Skills and Tasks Assessment Tool.
RESULTS
A total of 14 incoming fellows participated in the course. The mean scores for the 3D-AM across all six domains and across the three institutions was between 4 and 5, suggesting that learners generally had a favorable impression and a similar experience across different institutions. All learners "agreed" or "strongly agreed" that the course was a valuable use of their time, helped teach technical skills and airway anatomy, and would be useful for extra training during fellowship. Most of the learners correctly identified anatomy, bronchomalacia, and performed a BAL. Wall trauma was observed in 36% of learners.
CONCLUSION
The utility, low cost, and transferability of this model may create opportunities for PFB training across different institutions despite resource limitations in the United States and abroad.
PubMed: 38633515
DOI: 10.34197/ats-scholar.2023-0078OC -
Frontiers in Bioengineering and... 2023In the early childhood population, congenital airway conditions like bronchomalacia (BM) can pose a life-threatening threat. A breakthrough technology called additive...
In the early childhood population, congenital airway conditions like bronchomalacia (BM) can pose a life-threatening threat. A breakthrough technology called additive manufacturing, or 3D printing, makes it feasible to create a biomedical device that aids in the treatment of airway obstruction. This article describes how a polycaprolactone (PCL) splint for the upper airways can be created using the fusion deposition technique (FDM) and sterilized using gamma radiation. It is presented as a simple, accessible, and cost-reduced alternative that complements other techniques using more expensive and sophisticated printing methods. Thermomechanical and morphological analysis proved that FDM and sterilizing by gamma irradiation are both appropriate methods for producing splints to treat life-threatening airway blockages. Additionally, the 3D-printed splints' effectiveness in treating a young patient with BM that was life-threatening was assessed by medical professionals. In this regard, the case report of a patient with 34 months of follow-up is presented. Splints manufactured by this affordable 3D printing method successfully surpass breathing arrest in life-threatening airway obstruction in pediatric patients. The success of this procedure represents a fundamental contribution to the treatment of the population in countries where access to expensive and complex technologies is not available.
PubMed: 37456725
DOI: 10.3389/fbioe.2023.1148295 -
Jornal de Pediatria 2024In children with tracheobronchomalacia, surgical management should be reserved for the most severe cases and be specific to the type and location of...
OBJECTIVE
In children with tracheobronchomalacia, surgical management should be reserved for the most severe cases and be specific to the type and location of tracheobronchomalacia. The goal of this study is to describe the presentation and outcomes of children with severe tracheobronchomalacia undergoing surgery.
METHODS
Retrospective case series of 20 children operated for severe tracheobronchomalacia at a tertiary hospital from 2003 to 2023. Data were collected on symptoms age at diagnosis, associated comorbidities, previous surgery, age at surgery, operative approach, time of follow-up, and outcome. Surgical success was defined as symptom improvement.
RESULTS
The most frequent symptoms of severe tracheobronchomalacia were stridor (50 %), cyanosis (50 %), and recurrent respiratory infections (45 %). All patients had one or more underlying conditions, most commonly esophageal atresia (40 %) and prematurity (35 %). Bronchoscopy were performed in all patients. Based on etiology, patients underwent the following procedures: anterior aortopexy (n = 15/75 %), posterior tracheopexy (n = 4/20 %), and/or posterior descending aortopexy (n = 4/20 %). Three patients underwent anterior aortopexy and posterior tracheopexy procedures. After a median follow-up of 12 months, 16 patients (80 %) had improvement in respiratory symptoms. Decannulation was achieved in three (37.5 %) out of eight patients with previous tracheotomy. The presence of dying spells at diagnosis was associated with surgical failure.
CONCLUSIONS
Isolated or combined surgical procedures improved respiratory symptoms in 80 % of children with severe tracheobronchomalacia. The choice of procedure should be individualized and guided by etiology: anterior aortopexy for anterior compression, posterior tracheopexy for membranous intrusion, and posterior descending aortopexy for left bronchus obstruction.
Topics: Humans; Tracheobronchomalacia; Retrospective Studies; Female; Male; Infant; Treatment Outcome; Infant, Newborn; Child, Preschool; Bronchoscopy; Severity of Illness Index; Child; Follow-Up Studies
PubMed: 38278512
DOI: 10.1016/j.jped.2023.10.008 -
Brazilian Journal of Otorhinolaryngology Aug 2023Laryngomalacia is the most common congenital cause of stridor; the natural history of the disease runs through to complete resolution by the age of two. Severe cases are...
OBJECTIVES
Laryngomalacia is the most common congenital cause of stridor; the natural history of the disease runs through to complete resolution by the age of two. Severe cases are characterized by cyanosis, hypoxia, apnea, furcular and/or subcostal retractions, aspirations, pulmonary hypertension, and failure to thrive and must undergo surgery. This study aimed to evaluate the success rates of supraglottoplasty in our hospital and evaluate the predictive factors for surgical success.
METHODS
Cohort study, prospectively planned. 75 patients undergoing endoscopic surgery from July 2007 to July 2016 were analyzed at the Santo Antônio Children's Hospital. The primary outcome was percentage of surgical success, defined as the absence of respiratory symptoms or presence of a mild stridor without retractions on the first post-operative month (late success). The secondary outcomes were the early surgical success (absence of respiratory symptoms or presence of a mild stridor without retractions on the first post-operative day).
RESULTS
39 (58.2%) were male, with an average of 4.9 months. Surgical success on the first day was 80.6% (n=54). At the end of the 1st month, surgical success was 88.6%, considering only those who completed assessment. Twenty-one (34%) presented comorbidities. Presence of comorbidities, pharyngomalacia and GERD were associated with a worse result on the 1st postoperative day, whereas, at the end of the first month, presence of comorbidities, concomitant injuries (tracheo and bronchomalacia) and pharyngomalacia were the predictive variables of surgery failure.
CONCLUSION
Supraglottoplasty has high rates of efficacy and low morbidity. The presence of comorbidities and pharyngomalacia has shown association with a worse early and late surgical outcome. Synchronous airway lesions predict a worse surgical result at the end of the first month. GERD was associated with obstructive symptomatology only in the 1st post-operative day.
LEVEL OF EVIDENCE
Level 3 of evidence, according to the "The Oxford 2011 Levels of Evidence" from Oxford Centre for Evidence-Based Medicine.
PubMed: 37716096
DOI: 10.1016/j.bjorl.2023.101315 -
Frontiers in Cardiovascular Medicine 2024Published data estimate the prevalence of the vascular ring at approximately 7 per 10,000 live births. The association of a double aortic arch with a D-transposition of...
Published data estimate the prevalence of the vascular ring at approximately 7 per 10,000 live births. The association of a double aortic arch with a D-transposition of the great arteries has been rarely described in the literature. In this study, we report the prenatal diagnosis of a 28-year-old woman. A fetal echocardiography at a gestational age of 24 weeks + 6 days showed a D-transposition of the great arteries and a double aortic arch with a ventricular septal defect and pulmonary stenosis. On the first night after birth, the baby experienced an increase in lactate levels, with the rate of oxygen saturation consistently below 80%. A few hours after birth, the patient underwent a Rashkind procedure. An echocardiography, CT chest x-ray, and CT angiogram confirmed a diagnosis with a severe reduction of the tracheal lumen (>85%) and bronchomalacia. Then, the patient underwent posterior tracheopexy and aortopexy and later an arterial switch operation, ventricular septal defect closure, and resection of a part of the infundibular septum, accepting the risk of potential neoaortic obstruction. The literature has reported only two cases of patients with a fetal echocardiogram diagnosis. Therefore, our patient is only the third one with a fetal diagnosis and the second one with a complex intracardiac anatomy, characterized not only by a ventricular septal defect but also by two separate components of the obstruction (a bicuspid valve and a dysplastic valve with a posterior deviation of the infundibular septum). In conclusion, a D-transposition of the great arteries with a double aortic arch remains an extremely unusual association. The clinical outcome of these patients presents a high degree of variability and is entirely unpredictable in prenatal life. Our greatest aim as fetal and perinatal cardiologists is to improve the management and outcome of these patients through a fetal diagnosis, recognizing types of congenital heart disease in newborns who require early neonatal invasive procedures.
PubMed: 38682104
DOI: 10.3389/fcvm.2024.1351530