OPP7 A DECADE ENCOUNTERS OF TRACHEOBRONCHOMALACIA ASSOCIATED WITH PAEDIATRIC CONGENITAL HEART DISEASE

S.H Tan1 , Y.S.Ooi2 ,D.Z.Sahadan1
1Peadiatric Respiratory Unit, Hospital Sultan Idris Shah Serdang
2Paediatric Cardiology Unit, Hospital Sultan Idris Shah Serdang

Backgrounds: 

Patients with complex congenital heart disease (CHD) associated with tracheobronchomalacia (TBM) often pose challenges in management. We studied the influence of TBM on the outcomes of pediatric patients associated with congenital heart disease.

Objective: 

The aim of this study is to describe the clinical characteristics, underlying aetiologies, bronchoscopy findings and long term outcome of TBM in Hospital Sultan Idris Shah, Serdang.

Methods:

This is a retrospective observational study of 36 cases of TBM associated with paediatric congenital heart disease between March 2014- March 2024. Data were retrieved via e-His medical record. 

Results:

The median age of diagnosis was 3 months old (range 1 month -7 years old) and 61.1% were male (22/36). 83.3%(30/36) of patients had complex comorbidities and two third of them (66.7%) were syndromic. 55.6%(20/36) of the CHD were complex cyanotic heart diseases and 2.8%(1/36) associated with vascular ring/sling. Mostly had undergone cardiac surgery (86.1%,31/36). The commonest presentation was prolonged respiratory support (97.2%, 35/36). Majority of patients with TBM were confirmed via flexible bronchoscopy (97.2%, 35/36).  Almost half of the patients (47.2%,17/36) have bilateral bronchomalacia, 36%(13/36) have unilateral bronchomalacia ,13.8%(5/36) TBM and 2.8%(1/36) tracheomalacia. Most patients required home respiratory support (91.7%,33/36) which included CPAP (69.4%, 25/36) and BIPAP (22.2%, 8/36). Additionally, 19.4% (7/36) were on tracheostomy as well. Respiratory supports were successfully weaned off in 89% (32/36) of the patients. The mortality rate in our cohort was 8.3%(3/36) and came from those with complex comorbidities.

Conclusions:

The management of TBM with cardiac pathology is complex and the population of patients is very heterogeneous. Home ventilation remains the mainstay of management which produce a favourable clinical result in these group of patients.