Abstract:

Objective To investigate the effect of tracheobronchomalacia (TBM) on early recovery after surgical repair for different types of congestive congenital heart disease (CHD). Methods The clinical data of all the patients with congestive CHD hospitalized in intensive care unit of Department of Cardiovascular and Thoracic Surgery, Shanghai Children's Medical Center affiliated to Shanghai Jiaotong University School of Medicine between January 2007 and December 2010 were retrospectively analysed. Patients of each type of congestive CHD were divided into TBM group and non-TBM group according to the findings of bronchofiberscopy, and the clinical data and outcomes were compared. Results There were 237 cases of TBM diagnosed by bronchofiberscopy in 5 061 cases of congestive CHD, with the incidence of 4.7%. Coarctation of the aorta with ventricular septal defect, persistent truncus arteriosus and interruption of aortic arch with ventricular septal defect had the higher incidences of TBM, which were 34.68%, 29.17% and 28.00%, respectively. In patients with atrioventricular septal defect, ventricular septal defect and atrial septal defect, the age and body weight in TBM group were significantly lower than those in non-TBM group (P<0.05). In patients with transposition of the great arteries, the age and body weight in TBM group were significantly higher than those in non-TBM group (P<0.05). There was no significant difference in age and body weight between TBM group and non-TBM group in patients with the other types of CHD (P>0.05). Except for the patients with interruption of aortic arch with ventricular septal defect, those in TBM group of children with the other types of CHD had prolonged time of mechanical ventilation and/or duration of intensive care unit stay （P<0.05）. Conclusion TBM may lead to prolonged time of mechanical ventilation and duration of ICU stay in patients with congestive CHD, especially in young infants with low body weight. Evaluation of the airway conditions before surgery and design of the postoperative mechanical ventilation management are important.

Key words: congestive congenital heart disease, tracheobronchomalacia, mechanical ventilation, children