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Published in: Pediatric Surgery International 5/2019

01-05-2019 | Bronchoscopy | Original Article

Repair of type IV laryngotracheoesophageal cleft (LTEC) on ECMO

Authors: Insu Kawahara, Kosaku Maeda, Yoshitomo Samejima, Keisuke Kajihara, Kotaro Uemura, Kozo Nomura, Kaori Isono, Keiichi Morita, Hiroaki Fukuzawa, Makoto Nakao, Akiko Yokoi

Published in: Pediatric Surgery International | Issue 5/2019

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Abstract

Purpose

A type IV laryngotracheoesophageal cleft (LTEC) is a very rare congenital malformation. Type IV LTEC that extends to the carina have poor prognosis and are difficult to manage. We present our experience with surgical repair in such a case using extracorporeal membranous oxygenation (ECMO).

Methods

A male infant, who was diagnosed with Goldenhar syndrome, showed severe dyspnea and dysphagia. Laryngoscopy indicated the presence of LTEC. The patient was transferred to our institute for radical operation 26 days after birth. Prior to surgery, a balloon catheter was inserted in the cardiac region of stomach through the lower esophagus to block air leakage, to maintain positive pressure ventilation. We also performed observations with a rigid bronchoscope to assess extent of the cleft, and diagnosed the patient with type IV LTEC. After bronchoscopy, we could intubate the tracheal tube just above the carina. Under ECMO, repair of the cleft was performed by an anterior approach via median sternotomy.

Results

The patient was intubated via nasotracheal tube and paralysis was maintained for 2 weeks, using a muscle relaxant for the first 3 days. Two weeks after surgery, rigid bronchoscopy showed that the repair had been completed, and the tracheal tube was successfully extubated without tracheotomy.

Conclusions

Although insertion of a balloon catheter is a very simple method, it can separate the respiratory and digestive tracts. This method allowed for positive pressure ventilation and prevented displacement of the endotracheal tube until ECMO was established. As a result, we safely performed the operation and the post-operative course was excellent.
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Metadata
Title
Repair of type IV laryngotracheoesophageal cleft (LTEC) on ECMO
Authors
Insu Kawahara
Kosaku Maeda
Yoshitomo Samejima
Keisuke Kajihara
Kotaro Uemura
Kozo Nomura
Kaori Isono
Keiichi Morita
Hiroaki Fukuzawa
Makoto Nakao
Akiko Yokoi
Publication date
01-05-2019
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Surgery International / Issue 5/2019
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI
https://doi.org/10.1007/s00383-019-04455-8

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