101.16 Balloon Tracheoplasty as Primary Treatment of Congenital Tracheal Stenosis: A Case Series

R. Ahluwalia1, B. Kosko1, J. Foster2, J. Kosko1,3, C. Cotter1,3  1Florida State University College Of Medicine,Tallahassee, FL, USA 2Medical University Of South Carolina,Columbia, Sc, USA 3Orlando Regional Medical Center,Orlando, FL, USA

Introduction:
The purpose of this study was to review two cases of congenital tracheal stenosis treated only with serial balloon tracheoplasty and endoscopic techniques. We then performed a meta-analysis of the literature to identify cases of congenital tracheal stenosis treated by a similar mechanisms. Six other cases of congenital tracheal stenosis treated by balloon tracheoplasty were identified based off of our literature search. Serial balloon dilation combined with adjuvant methods such as laser can be performed in cases of short-segment tracheal stenosis. Our case illustrations demonstrate the efficacy of this treatment modality via long-term follow up of 8 and 4 years respectively. Large amounts of data have been published on other treatment mechanisms of congenital tracheal stenosis such as end-to-end anastomosis of the trachea or slide tracheoplasty. Balloon tracheoplasty is a modern and innovative approach to short-segment tracheal stenosis which mandates additional research.

Methods:
We conducted a meta-analysis of the literature in order to consolidate case reports that also employed the use of endoscopic management and balloon tracheoplasty in children with congenital tracheal stenosis. In our review of the literature, limited cases were found in which balloon tracheoplasty was employed as the sole method of treatment. We consolidated this review of the literature with two case series provided by our institution. Number of patients, sex, age, symptoms at presentation, associated conditions, morphology of stenosis, treatment, pronosis, and length of follow up was compared. 

Results:
All in all, in reviewing balloon tracheoplasty over the past 15 years, the outcomes have been beneficial for all patients in the acute setting. In one study, 44% of children gained long-term improvement after undergoing balloon tracheoplasty for various causes. Also, 50% of children who could not originally tolerate removal of the tracheotomy tube proceeded to eventually be extubated.The longest follow up reported in the literature was 48 months post initial presentation. Our case series is unique in that the follow up period is 8 and 4 years, respectively and the the respiratory status of both patients has been progressively increasingimproving. Our cases demonstrate the efficacy of endoscopic management facilitated by balloon tracheoplasty as a reasonable initial approach to short segment congenital tracheal stenosis.

Conclusion:
In conclusion, expiratory stridor in a neonate should raise concern for possible congenital tracheal stenosis. In particular cases of short segment tracheal stenosis we have demonstrated the efficacy of endoscopic management facilitated by balloon tracheoplasty via a two case-series. More research is required on this topic as a possible treatment modality, but our cases serve as a primer to long-term follow up of this treatment option.