Excessive Tracheal Length in Patients With Congenital Tracheal Stenosis

Background. Slide tracheoplasty is the preferred approach for treating long-segment congenital tracheal stenosis (CTS). However, little research has been conducted on the tracheobronchial anatomy before and after slide tracheoplasties in patients with CTS. Methods. We reviewed 23 patients with CTS who received slide tracheoplasties. We measured the intrathoracic tracheal length and the carina angle from computed tomography images. To account for each patient's body size, we divided the intrathoracic tracheal length by the length of the thorax to obtain the tracheathorax ratio (TTR). These measurements were used to compare patients before and after slide tracheoplasties as well as normal control subjects. Results. Two patients had upper tracheal CTS and 21 patients had lower tracheal CTS. For the 21 patients with lower tracheal stenosis, their TTRs before slide tracheoplasty were 0.42 +/- 0.04, which were significantly larger than those of the control subjects (0.32 +/- 0.04; p < 0.0001). After slide tracheoplasty, the TTR was 0.32 +/- 0.04, similar to the control TTRs (p = 0.94). The carina angle was significantly wider in the 21 patients than in the control subjects (120.7 +/- 11.7 degrees versus 86.4 +/- 13.1 degrees; p < 0.0001). After slide tracheoplasty, the carina angle was significantly narrower (from 120.7 +/- 11.7 degrees to 92.2 +/- 15.2 degrees; p < 0.0001), which was similar to control subjects. Conclusions. The trachea was longer and the carina angle wider in patients with lower tracheal CTS than in control subjects. Excessive tracheal length is favorable for slide tracheoplasty. Slide tracheoplasty not only corrects CTS, but also restores tracheobronchial morphology. (C) 2019 by The Society of Thoracic Surgeons