Abstract
Introduction Esophageal atresia (EA) is often accompanied by tracheobronchial malformations leading
to stridor, recurrent bronchitis, and occasionally to life-threatening obstructive
apnea after surgical repair. The aim of this study was to identify the presence of
tracheomalacia in patients with EA and tracheoesophageal fistula (TEF) pre- and postoperatively
and to find endoscopic correlates leading to clinical airway symptoms.
Methods In a cohort of 362 patients with EA-TEF who underwent 595 tracheoscopies at the Children's
Hospital of Cologne between January 1983 and December 2002, impaired tracheal lumen,
localization of TEF, tracheal pulsations, and corresponding clinical symptoms were
retrospectively analyzed.
Results The incidence of tracheomalacia was higher in patients with EA and TEF (Gross B–D)
compared with patients with EA alone (Gross A) and average tracheal collapse does
not significantly change before and after surgical repair of the esophagus in all
types. Patients with cyanosis while eating and obstructive apnea presented with an
average tracheal collapse of 89%. The presence of respiratory symptoms such as cough,
stridor, or bronchitis was not associated with a higher grade of tracheal collapse
compared with patients without any airway symptoms (average tracheal collapse of 37%
in symptomatic patients vs. 33% in nonsymptomatic patients).
Conclusion Tracheomalacia tends to be present independently of surgical procedure. Tracheomalacia
should be measured by tracheoscopy (in % of tracheal collapse). Patients with a tracheal
collapse of >80%, a ventral pulsation, and obstructive apnea or cyanosis in combination,
are at risk for life-threatening situations and further surgical treatment should
be considered.
Keywords
tracheal collapse - tracheomalacia - laryngotracheobronchoscopy - tracheoesophageal
fistula
