All issues > Volume 48(7); 2005

Original Article

Korean J Pediatr. 2005;48(7):737-744. Published online July 15, 2005.

Airway Compression or Airway Anomaly Causing Respiratory Symptoms in Infants and Children with Cardiovascular Diseases

Ja-Hyeong JH Kim¹, So-Yeon SY Lee², Hyo-Bin HB Kim², So-Eun SE Koo², Sung-Jong SJ Park², Young-Hui YH Kim², In-Suk IS Park², Jae-Kon JK Ko², Dong-Man DM Seo³, Soo-Jong SJ Hong²

¹Department of Pediatrics, Ulsan University Hospital, Ulsan, Korea
²Department of Pediatrics, Asan Medical Center, College of Medicine, Ulsan University, Seoul, Korea
³Department of Cardiac Surgery, Asan Medical Center, College of Medicine, Ulsan University, Seoul, Korea

Correspondence Soo-Jong SJ Hong ,Email: sjhong@amc.seoul.kr

Abstract

Purpose
: Infants and children with cardiovascular diseases often present with respiratory symptoms. However, missed or delayed evaluation for potential airway problem may complicate overall prognosis. The aim of this study is to determine the clinical characteristics of these patients and explore the cause of airway problem.
Methods
: We reviewed the medical records of 64 patients(M : F=33:31, mean age : 6.3±7.5 months) whose airway problems were proven by computed tomography or bronchoscopy in perioperative periods at the Asan Medical Center from January 1997 to June 2004. Patients were divided into two groups based on the duration of ventilator care : ≤7 days(group 1 : 23 cases, M : F=10 : 13) and >7 days(group 2 : 41 cases, M : F=23 : 18).
Results
: The patients in group 2 significantly developed more post-operative respiratory symptoms than group 1(P<0.001) and had more airway problems including extrinsic obstruction, intrinsic anomaly, and combined problem than group 1 although not significantly different(P=0.082). Among underlying diseases, the most common diseases were vascular anomaly(26.2 percent) and aortic arch anomaly(26.2 percent) in group 1 and pulmonary atresia with ventricular septal defect(22.4 percent) in group 2. The most frequent respiratory symptoms were recurrent wheezing pre-operatively and failure of ventilator weaning post-operatively. The major types of airway anomaly were tracheomalacia and tracheal stenosis(in each case 18.2 percent). Nineteen patients with persistent airway problems underwent aortopexy or other vascular correction. Of the 19 patients, 13(68.4 percent) were improved, but 2 failed in weaning ventilator and 4 died of non-airway problems.
Conclusion
: Early evaluation and treatment for potential airway problems may affect natural or surgical prognosis in patients with cardiovascular diseases presenting with respiratory symptoms.

Keywords :Cardiovascular diseases , Airway problem , Computed tomography , Bronchoscopy , Aortopexy