Airway abnormalities in children with congenital heart disease

Airway abnormalities in children with congenital heart disease <bold>Background:</bold> Congenital heart disease (CHD) is the most common congenital anomaly diagnosed in Europe, affecting 8 in 1,000 live births. Multiple congenital abnormalities affect 15.8 births per 10,000 and CHD is present in half of these. There is significant symptom crossover in CHD and structural airway abnormalities (SAA). <bold>Objectives:</bold> To investigate types and frequency of SAA in children with CHD and clinical outcomes. <bold>Methods:</bold> CHD patients under the care of East Midlands Congenital Heart Centre between April 2010-2020 with SAA were identified from the local database. Records were reviewed to define airway, ventilatory and surgical support required, and assess outcomes over time. <bold>Results:</bold> 82 patients with comorbid CHD and SAA were managed during the period. The median age was 3 years (range 3 months-12 years); 46.3% had 2 or more SAA. The most common SAA were bronchomalacia (45.1%), tracheomalacia (39.0%) and vocal cord palsy (22.0%). At diagnosis, 71.6% required surgical or medical airway intervention; 27/82 (32.9%) required tracheostomy and 37.0% of patients with tracheostomy achieved decannulation during the period. Average time to decannulation was 25.5 months (range 3-45 months). The proportion of tracheostomy patients requiring continuous mechanical ventilation decreased from 13.6% to 8.7% at 1-year. <bold>Conclusion:</bold> Bronchomalacia, tracheomalacia and vocal cord palsy are the most common SAA in children with CHD. Airway support is required mainly in the first two years, with reduced rates of ventilator dependence as patients age. There should be a high index of suspicion to investigate children with unresolved respiratory symptoms post cardiac intervention for SAA.