Airway compression in children with congenital heart disease evaluated using computed tomography

Abstract

Background: Extrinsic airway compression often complicates the course of congenital heart disease (CHD) repair. This study investigated the risk factors and outcome of airway compression evaluated using computed tomography (CT) in CHD patients.

Methods: Of the 2,729 patients who underwent heart surgery for CHD between 1999 and 2007, airway compression was confirmed using CT in 58 (2.1%) patients. The patients were divided into groups according to the underlying CHD, and their medical records and CT scans were reviewed retrospectively.

Results: Airway compression was found more frequently in the vascular ring or absent pulmonary valve syndrome (8 of 11) and repaired aortic arch (22 of 213) groups than in the other groups (28 of 2,505) (p < 0.001). Patients with more severe respiratory manifestations showed greater airway compression on CT (p < 0.001) and had a higher rate of additional surgery to relieve airway compression using multivariate analysis (p = 0.005). Airway compression was ameliorated in 13 of 17 patients after surgery for airway compression. Funnel chest deformity worsened after aortic arch repair and was associated with the need for surgical relief of airway compression. Pulmonary overflow disease could be followed up without additional surgery for airway compression.

Conclusions: Early airway compression detection and management may reduce further morbidity, especially after aortic arch repair. The patient's respiratory manifestation and the underlying disease characteristics must be considered when determining the need for additional surgery for airway compression.

Keywords: 20; AA group; AC; AC ratio; Additional SAC; CHD; CT; FC ratio; Group 1; Group 2; IA ratio; LRS group; RVOT group; SAC; SAC after first surgery for underlying heart disease; VR group; airway compression; computed tomography; congenital heart disease; funnel chest deformity ratio; interaortic distance ratio; pulmonary overflow disease (left to right shunt) group; ratio of the compressed airway diameter to the trachea; reconstruction of the right ventricular outflow tract group; repaired aortic arch group; surgery for airway compression; vascular ring or absent pulmonary valve syndrome group; with SAC (2A = simultaneous, 2B = additional); without SAC.