case_images: PMC10944969_01
case_images: Preoperative examination of the patient. A computed tomography scan of his chest revealed that the lumen above the tracheal carina was narrow, with a diameter of approximately 1.7 mm at its narrowest point and involvement of approximately 7 mm in length (A-C). We were going to operate on the infant with ECMO-assisted tracheal resection and end-to-end anastomosis (D).
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case_images: F1
case_images: A chest computed tomography scan showed stenosis above the tracheal carina, with a narrowest diameter of approximately 1.7 mm and a length of approximately 7 mm (Figures 1A-C). To address the issue of tracheal stenosis in the infant, we decided to perform an ECMO-assisted tracheal resection and end-to-end anastomosis on the 22nd day after birth, following exclusion of surgical contraindications (Figure 1D).
case_images: Surgical procedures. Central venoarterial (VA) ECMO with right atrial cannulation for venous drainage and aortic return cannulation was used (A) We isolated the azygos vein and doubly ligated and divided the azygos vein with a 3-0 suture (B) In a position anterior to the trachea and posterior to the phrenic nerve, we opened the mediastinal pleura, freeing out the lower trachea. The distal and proximal segments of the tracheal stenosis were cut with a scalpel, and the tracheal stenosis segment was removed, followed by continuous suturing of the tracheal stump with 4-0 absorbable sutures to complete an end-to-end anastomosis (C-F).
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case_images: PMC10944969_01_fped-12-1363419-g002.jpg
case_images: F2
case_images: Upon entering the thoracic cavity, we established ECMO access using central venoarterial (VA) cannulation with right atrial drainage and aortic return cannulation, connected to 1/4" inner diameter tubes (Figure 2A). We then isolated the azygos vein and divided it after doubly ligating it with a 3-0 suture (Figure 2B). We completed the end-to-end anastomosis by suturing the distal and proximal segments of the tracheal stump continuously with 4-0 absorbable sutures (Figures 2C-E).
case_images: Postoperative examination of the patient. (A) Tracheal stenosis segment and tracheal margins; (B) Postoperative pathological results revealed chronic inflammation of bronchial mucosa with polypoid hyperplasia. On the fourth postoperative day, the infant's endotracheal tube was removed and switched to nasal noninvasive ventilator-assisted ventilation (C) After two chest drains were removed, the infant continued to receive treatment in a warm box (D).
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case_images: F3
case_images: The infant was then transferred to the NICU for postoperative tracheal intubation, and specimens were sent to the pathology department while also being presented to the family (Figure 3A).