| Background and Objective The symptoms caused by the airway anomalies are often masked by symptoms of heart disease in patients with congenital heart disease(CHD) that is most common in child patients. With continuously developing and progressing respiratory medical technology, more and more attention has been paid on diagnosing CHD with airway anomalies. However, the studies have mostly focused on individual application of bronchoscopy or multidetector computed tomography(MDCT) to diagnose CHD with airway anomalies; and there have been few reports on the combined application of bronchoscopy and MDCT for such diagnosis. In this study, the effectiveness of applying both electronic bronchoscopy(EB) and MDCT in the diagnosis of the CHD with airway anomalies in child patients is evaluated. The advantages and disadvantages of EB and MDCT examinations are compared and discussed. Methods During March 2014 and December 2015, in Anhui Provincial Children’s hospital, EB and MDCT examinations were performed on 70 CHD children with symptoms of “recurrent respiratory tract infection, recurrent or persistent coughing, wheezing, refractory pneumonia or atelectasis, intubation or withdrawing the mechanical ventilation difficulty” that are suspected with airway development anomalies. The clinical data and results of two examinations were compared and analyzed. Results Among 70 CHD child patients, there were 61 patients of airway anomalies, at a rate of 87.1%(61/70). The detection rate of airway anomalies examined by EB was 85.7%(60/70)and 60.0%(42/70) by MDCT examination. The difference between EB and MDCT was statistically significant(χ2=14.5, p<0.05).Among 61 patients with airway anomalies, there were 38 patients with airway stenosis(total of 48 cases, 12 cases with tracheal stenosis, 21 cases with left main bronchial stenosis, 9 cases with right main bronchial stenosis and 6 cases with lobar bronchial stenosis,respectively), accounting for 54.3%(38/70); 37 patients with airway malacia(total of 50 cases, 8 cases with laryngomalacia, 22 cases with tracheal malacia, 9 cases with left main bronchial malacia, 7 cases with right main bronchial malacia, 4 cases with lobar bronchial malacia, respectively), accounting for 52.9%(37/70); 10 patients with bronchial anomalous origin(7 cases with tracheal bronchus, 3 cases with bridging bronchus), accounting for 16.4%14.3%(10/70); 5 cases with vocal cord paralysis or glottal closure insufficiency, 5 cases with tracheo-esophageal fistula, 4 cases with tongue cyst, 2 cases with transposition of the bronchial tree, 1 case with pulmonary cyst, 1 case with right pulmonary aplasia, and 1 case with right pulmonary hypoplasia.There were 29 patients,41.4%(29/70), with pure airway anomalies, and 32 patients, 45.7%(32/70), with no less than two types of airway anomalies. Among all kinds of airway anomalies, airway stenosis, bronchial anomalous origin, tongue cyst, tracheo-esophageal fistula and right pulmonary aplasia could be diagnosed by either EB or MDCT. Airway malacia, vocal cord paralysis or glottal closure insufficiency were only diagnosed by EB, and there was no effective diagnosis by MDCT. Pulmonary cyst and right pulmonary hypoplasia were only diagnosed by MDCT, and EB was not able to observe the distal of severe airway stenosis and the outer organization structure of trachea. 10 patients with atelectasis underwent bronchoalveolar lavage by EB, 8 patients achieved partial or complete recruitment in 1-2 weeks. There were 31 patients’ bronchoalveolar lavage fluid for culture with 4 cases being positive.Conclusions CHD children have a high incidence rate and various types of airway anomalies, in which airway stenosis, airway malacia and bronchial anomalous origin are most common. Overall, the diagnosis effectiveness of EB examination on CHD with airway anomalies is better than MDCT; however, MDCT can be supplementary to the EB examination in diagnosis of the distal of severe airway stenosis and the outer organization structure of trachea. And EB has certain therapeutic effects on airway inflammation and atelectasis. Combined application of EB and MDCT is more conducive to a comprehensive assessment of CHD associated with airway anomalies. |
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