Balloon dilatation in apnoea in acquired infantile subglottic stenosis

Introduction Although the treatment of congenital and acquired subglottic stenosis in children has improved in recent years, therapeutic decision remains difficult. Often it concerns children with multiple pre-existing diagnoses and subglottic stenosis only becomes apparent in the setting of a decompensated oxygenation or emergency situation. Medical history A 6-month-old child with trisomy 21 and persistent respiratory problems was presented as an emergency case due to impending respiratory decompensation. 4 weeks earlier, the patient had been hospitalized for 2 days for stenosic laryngotracheitis secondary to acute COVID-19 infection. Two months earlier the child had undergone surgical AVSD correction followed by 5 days of intensive care including invasive ventilation.

Results After ineffective conservative therapy, bronchoscopy was performed in the presence of increasing inspiratory and expiratory stridor. A residual subglottic gap of about 1 mm was found (grade III according to Myer-Cottin). Emergent dilatation using a 6 mm cardiac balloon catheter was performed over 30 seconds in apnoea. After stabilisation of the child under laryngeal mask, it was intubated to a 3 mm tube without cuff. This was followed by a 2-minute off-label application of mitomycin to the stenotic tissue. Extubation was performed after 5 days with following stable oxygenation without support. Bronchoscopy on day 6, after one and 5 months showed no relevant re-stenosis.

Conclusions  Balloon dilatation is an efficient and safe technique for the treatment of high-grade acquired infantile subglottic stenosis that should be included in interdisciplinary treatment planning and ideally makes tracheostomy unnecessary.

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Artikel online veröffentlicht:
12. Mai 2023