Lower airway anomalies in children with CATCH 22 syndrome and congenital heart disease

Abstract

Patients with CATCH 22 syndrome and CHD had a shorter length of trachea compared to that of the age-matched similar CHD. The incidence of associated lower airway anomalies in CHD children with CATCH 22 syndrome was higher. It may lead to longer time of ventilator support after surgery as well as total hospital stays than those of CHD without CATCH 22 syndrome.

Safety of tracheal intubation in the presence of cardiac disease in paediatric ICUs

“…Congenital airway anomalies are common in children with CHD, and certain difficult airway features may be associated with multiple intubation attempts and desaturations, as we observed with children who had a limited mouth opening. 6,20 A population-based study in Taiwan found an increased risk of mortality in children with CHD if they also had congenital airway anomalies. 13 Providers should also be cognizant that undiagnosed airway anomalies, such as subglottic stenosis and laryngomalacia, may be present.…”

“…3 In addition to the baseline risk of adverse events during tracheal intubation, children with underlying cardiac disease in ICUs often have cardiogenic shock, a higher prevalence of airway abnormalities, and unique pathophysiology that can augment this risk. [4][5][6] Studies specifically evaluating this population are essential to decreasing their rates of tracheal-intubation-associated events. We seek to fill this knowledge gap by using an expansive airway registry developed by NEAR4KIDS.…”

Use of rotational angiography in assessing relationship of the airway to vasculature during cardiac catheterization

“…Postoperative and postprocedural imaging by MRI , CT , and bronchoscopy have shown that the airway can be compressed by dilated vasculature and patients may develop respiratory symptomatology. However, CT and bronchoscopy are not without risks.…”

“…However, CT and bronchoscopy are not without risks. With the presence of both upper and lower airway anomalies in CHD patients , limiting the use of these procedures while still having a reliable diagnostic tool will be critical. In this study, we showed the feasibility of an alternative imaging modality of airways in children already undergoing cardiac catheterization.…”

“…In neonates with CATCH 22 syndrome which may be associated with up to 50% of conotruncal abnormalities , the prevalence of tracheal or bronchial stenosis diagnosed by computed tomography (CT) may be as high as 56% . A factor contributing to the high prevalence may be due to the shorter trachea seen in these children with characteristic dysmorphic facial features . Associated congenital anomalies can also cause extrinsic airway compression, including vascular rings, dilated pulmonary arteries with or without left atrial enlargement, anomalous aortic or pulmonary arterial course, and dilated aorta .…”