Background: This study investigated the morphologic characteristics of congenital heart disease (CHD) combined with anomalous tracheobronchial arborization (ATBA) to provide new considerations for surgically treating congenital tracheal stenosis.
Methods: A retrospective review of surgical experience with ATBA was conducted of 147 patients. The proportion of patients with ATBA combined with tracheal stenosis was determined. Four ATBA types were identified: type A, tracheal bronchus (n = 58); type B, bronchial trifurcation (n = 46); type C, bridging bronchus (n = 38); and type D, tracheal bronchus combined with bronchial trifurcation (n = 5). The rate of tracheoplasty for each type was determined. We measured the carina/pseudocarina angle and assessed the distribution of CHD, especially pulmonary artery sling.
Results: The tracheal diameter of 14 patients (24.1%) with type A and 5 patients (10.9%) with type B was normal. There were 128 patients with tracheal stenosis and complete tracheal rings; of them, 113 patients received tracheoplasty. The tracheoplasty rate was higher for type C than type A (100% vs 62.1%, P < .001). The carina/pseudocarina angle was significantly reduced postoperatively (P < .001). The repair in 78 patients (60.9%) was combined with a pulmonary artery sling. A pulmonary azygos lobe was found in 10 patients (6.8%) and was resected.
Conclusions: ATBA is common in patients with congenital tracheal stenosis and may be associated with abnormal embryonic development. The new classification of ATBA has clinical significance in treating patients with congenital tracheal stenosis. The poor tracheal development cannot be explained merely with vascular compression. Tracheoplasty is currently the optimal option for every type.
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