Fetoscopic balloon dilation and stent placement of congenital high airway obstruction syndrome leading to successful Caesarian delivery

Introduction: Without fetal or perinatal intervention, congenital high airway obstruction syndrome (CHAOS) is a fatal anomaly. The ex utero intrapartum treatment (EXIT) procedure has been used to secure the fetal airway and minimize neonatal hypoxia, but is associated with increased maternal morbidity. Case Presentation: A 16-year-old woman (gravida 1, para 0) was referred to our hospital at 31 weeks gestation with fetal anomalies, including echogenic lungs, tracheobronchial dilation and flattened diaphragms. At 32 weeks, fetoscopic evaluation identified laryngeal stenosis, which was subsequently treated with balloon dilation and stent placement. The patient developed symptomatic and regular preterm contractions at post-operative day 7 with persistent sonographic signs of CHAOS, which prompted a repeat fetoscopy with confirmation of a patent fetal airway followed by Cesarean delivery under neuraxial anesthesia. Attempts to intubate through the tracheal stent were limited and resulted in removal of the stent. A neonatal airway was successfully established with rigid bronchoscopy. Direct laryngoscopy and bronchoscopy confirmed laryngeal stenosis with a small tracheoesophageal fistula immediately inferior to the laryngeal stenosis and significant tracheomalacia. A tracheostomy was then immediately performed for anticipated long term airway and pulmonary management. The procedures were well tolerated by both mom and baby. The baby demonstrated spontaneous healing of the tracheoesophageal fistula by day of life 7 with discharge home with ventilator support at three months of life. Conclusion: Use of repeated fetoscopy in order to relieve fetal upper airway obstruction offers the potential to minimize neonatal hypoxia, while concurrently decreasing maternal morbidity by avoiding an EXIT procedure. Use of the tracheal stent in CHAOS requires further investigation. The long-term reconstruction and respiratory support of children with CHAOS remain challenging

A Review of Recent Patents on Structures Related to Tracheal Stents

Background: The trachea is an important part of the respiratory system. Long-term airway diseases and the effects of human physiological conditions can cause trachea stenosis. This will seriously affect patients’ physical health. Tracheal stents can provide durable support by means of dilating the narrowed area; they can effectively relieve the patient's breathing difficulties, which is of value that is more practical. Objective: To meet the vital requirements for better adaptation to the human airway environment and prevent complications associated with stent placement, the construction and materials of tracheal stents have been improved constantly. Methods: This paper investigates various representative patents related to the tracheal stent. The structure type, placement method and applications situation of these tracheal stents are discussed. Results: The characteristics of different types of tracheal stents are analyzed. This paper analyzes the main problems in its development. The solutions to the issues and the current and future research on tracheal stents are discussed. Conclusion: The tracheal stents are classified into metal stent, silicone stent, biodegradable stent and hybrid material stent. Further improvements are needed in the aspects of structural design, safety, applicability, biocompatibility, algorithm of drive model of tracheal stent. More related patents about tracheal stents need to be developed.

The Effects of Mycophenolate on the Formation of Granulation Tissue Post-operatively in Canine Tracheal Stent Patients (2014–2020)

Objectives: To determine if mycophenolate mofetil reduces the incidence and severity of granulation tissue in-growth in canine tracheal stent patients.Study design: Randomized clinical trial.Animals: 111 dogs from the hospital population.Methods: Client-owned dogs that received an endoluminal self-expanding tracheal stent for canine tracheal collapse between 2014 and 2020 were randomly assigned into one of two treatment groups. Control group medication protocol consisted of prednisone 0.5 mg/kg PO BID/SID/EOD × 30 days, hydrocodone 0.25 mg/kg PO TID × 30 days, and cefovecin 8 mg/kg SQ post-placement. Mycophenolate group medication protocol was identical to the control group medication protocol with the addition of mycophenolate mofetil 10 mg/kg PO BID × 30 days, SID for life. Recheck tracheoscopy was performed at 1, 3, and 6 months post-stent placement. Presence and severity of granulation tissue were determined by tracheoscopy and were recorded as a percentage of tracheal lumen obstruction by blinded evaluators (none present, <25%, >25–50%, and >50%).Results: At none of the three time points was there a statistically significant difference in grade between controls and those receiving mycophenolate (p = 0.467, p = 0.330, and p = 0.410).Conclusions and Clinical Significance: Our results suggest that mycophenolate can be safely given to these patients but do not support that its administration will reduce the incidence and severity of granulation tissue. Although a difference was observed in the severity of granulation tissue between the two groups, loss to follow-up may have influenced conclusions. A larger study would be warranted to further evaluate the effect of mycophenolate on the development of granulation tissue.

Double hitch stitch is a novel technique for fixation of tracheal stent in a case of tracheoesophageal fistula: a case report

Background Caudal tracheal stent migration can be potentially life threatening by causing distal luminal obstruction. We present a rare double hitch stitch procedure (for prevention of migration of tracheal stent), which is an external fixation technique in a case of tracheoesophageal fistula with tracheal and esophageal self-expandable metallic stent (SEMS). Case presentation A 50-year-old male patient who presented with cough and dyspnea was a known case of carcinoma of the esophagus with esophageal stent in situ. Computed tomography (CT) scan showed tracheoesophageal fistula with esophageal stent (esophageal SEMS) migrating into the trachea. Tracheal stenting was done with SEMS. Patient was followed up after 1 month with recurrent complaints of cough on deglutition. On follow-up bronchoscopy, migration of stent was observed. A rare procedure of double hitch stitch was performed with fixation of the tracheal stent (tracheal SEMS) using a percutaneous anchoring stitch, embedded in the subcutaneous tissue. Follow-up bronchoscopy after 1 month of the procedure showed no migration of stent. Conclusion For the treatment of large tracheoesophageal fistula, stenting of both the trachea and the esophagus along with the double hitch stitch proved to be lifesaving. Stent migration prevention using “double hitch-stitch” is simple, safe, and successful, without any complications.

PercuTwist tracheostomy in an intubated patient with tracheal stent

The optimal placement of a tracheal tube following percutaneous dilator tracheostomy is technically demanding in patients with tracheal stents. We report a successful technique of tracheostomy tube placement with PercuTwist in an intubated patient with a tracheal stent for malignant stenosis. The endotracheal tube was replaced with a laryngeal mask, a 9.0-mm tracheostomy tube was inserted into the trachea over a PercuTwist percutaneous dilator and through the tracheal stent under video-bronchoscopic vision. The PercuTwist technique kept the lumen of trachea, a laryngeal mask enabled adequate ventilation, and a video-bronchoscope guided the prompt insertion of the tracheostomy tube through the stent.