Airway pathologic abnormalities in symptomatic children with congenital cardiac and vascular disease

Abstract

Objective: To identify the epidemiological profile of airway abnormalities in symptomatic children with cardiac or vascular anomalies.

Design: Retrospective medical chart review.

Setting: Tertiary referral pediatric hospital.

Patients: Children with airway-related symptoms and coexistent cardiac or vascular abnormality were included. The source for patient identification was a prospectively kept database.

Main outcome measures: Endoscopic airway diagnoses, presenting airway symptoms, cardiac diagnoses, other comorbid conditions and pertinent diagnoses, patient demographics, source of referral, treatments, and follow-up.

Results: The study population comprised 77 patients (45 male and 32 female; mean age, 18.2 months) treated between June 2002 and July 2006. Only 4 patients had no findings. The most common airway abnormality was laryngeal paralysis (n=32), followed by subglottic stenosis (n=18). Congenital and acquired lesions were equally encountered (n=70 and n=64, respectively). The most frequent presentation was intolerance to feed (n=51) (stridor and/or failure of extubation). Of the 77 patients, 32 (42%) required airway surgical intervention (open vs closed); 36 (47%) still require otolaryngologic follow-up; and 32 (42%) had a named syndrome or general multisystem condition.

Conclusions: At least 3% of all children with cardiac disease will harbor airway problems. Laryngeal paralysis was the most common problem encountered. Given the successes achievable in treating children with complex cardiac abnormalities, attention should be paid to concomitant and consequential airway problems. Counseling processes should acknowledge the role of early otolaryngologic involvement.