Correlation of Tracheomalacia Severity With Esophageal Gap Length as Assessed by Ultrashort Echo-time MRI.

Autor: von Allmen DC; Cincinnati Children's Hospital Medical Center, Department of Otolaryngology, Cincinnati, OH, USA; University of Cincinnati School of Medicine, Department of Otolaryngology, Cincinnati, OH, USA. Electronic address: Douglas.vonallmen@cchmc.org., Hysinger EB; Cincinnati Children's Hospital Medical Center, Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati, OH, USA; University of Cincinnati School of Medicine, Department of Pediatrics, Cincinnati, OH, USA., Bates AJ; Cincinnati Children's Hospital Medical Center, Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati, OH, USA; University of Cincinnati School of Medicine, Department of Pediatrics, Cincinnati, OH, USA., Higano NS; Cincinnati Children's Hospital Medical Center, Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati, OH, USA; University of Cincinnati School of Medicine, Department of Pediatrics, Cincinnati, OH, USA., Garrison A; Cincinnati Children's Hospital Medical Center, Department of Surgery, Cincinnati, OH, USA; University of Cincinnati School of Medicine, Department of Surgery, Cincinnati, OH, USA., Walther A; Cincinnati Children's Hospital Medical Center, Department of Surgery, Cincinnati, OH, USA; University of Cincinnati School of Medicine, Department of Surgery, Cincinnati, OH, USA., de Alarcon A; Cincinnati Children's Hospital Medical Center, Department of Otolaryngology, Cincinnati, OH, USA; University of Cincinnati School of Medicine, Department of Otolaryngology, Cincinnati, OH, USA., Woods J; Cincinnati Children's Hospital Medical Center, Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati, OH, USA; University of Cincinnati School of Medicine, Department of Pediatrics, Cincinnati, OH, USA., Kingma P; University of Cincinnati School of Medicine, Department of Pediatrics, Cincinnati, OH, USA; Cincinnati Children's Hospital Medical Center, Division of Neonatology and Pulmonary Biology, Cincinnati, OH, USA.
Jazyk: angličtina
Zdroj: Journal of pediatric surgery [J Pediatr Surg] 2024 Nov; Vol. 59 (11), pp. 161880. Date of Electronic Publication: 2024 Aug 28.
DOI: 10.1016/j.jpedsurg.2024.161880
Abstrakt: Introduction: Tracheomalacia severity is difficult to quantify, however, ultrashort echo-time MRI objectively quantifies tracheomalacia in infants without sedation, radiation, or intubation. Patients with tracheoesophageal fistula and esophageal atresia (TEF/EA) commonly have tracheomalacia, however, the relationship between tracheomalacia severity and esophageal atresia has not been well defined. The primary objective of this study was to establish the relationship between EA and tracheomalacia severity and identify possible predictors of tracheomalacia severity.
Methods: A retrospective review of neonates with TEF/EA who had previously undergone UTE MRI was performed. The trachea was divided into thirds. Maximal eccentricity in each third was calculated by measuring the anterior posterior dimension (MinD) and dividing it by the maximum width of the trachea (MaxD). Frequency of respiratory related admissions, number of upper respiratory infections, and number of steroids courses were quantified in addition to eccentricity in short and long gap esophageal atresia patients.
Results: A total of 16 TEF/EA patients were included. Patients with long gap esophageal atresia had more severe tracheomalacia than short gap as measured by eccentricity in the upper (0.60 vs 0.72, p = 0.03), middle (0.48 vs 0.61, p = 0.02), and lower (0.5 vs 0.65, p = 0.01) trachea. Long gap esophageal atresia patients had more frequent respiratory readmissions (1.87 admissions/year vs 0.54 admissions/year) (p = 0.03). Following TEF/EA repair the trachea was less eccentric in the upper third (0.64 pre, 0.79 post, p < 0.01) and more eccentric in the lower third (0.69 pre, 0.56 post, p < 0.01).
Conclusion: Differences in esophageal gap and repair status correlate with airway eccentricity and tracheomalacia symptoms.
Competing Interests: Conflicts of interest None.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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