Carinal reconstruction… more than a challenge
Diana Romero1, Miguel Perilla1, Carlos Blanco1, Camila Montero2, Carolina Zuluaga1, Ana Garcés2
1Clínica Shaio
2Universidad Nacional de Colombia, Fundación Hospital pediátrico La Misericordia
Purpose
To describe three pediatric patients who underwent carinal reconstruction between December 2016 and March 2025, outlining the underlying pathology, clinical presentation, surgical approach, and outcomes.
Methods
A retrospective review of medical records and imaging was conducted for pediatric patients who required carinal reconstruction. Data collected included demographics, clinical presentation, type of airway pathology, surgical technique, and postoperative evolution.
Results
Three patients underwent carinal reconstruction:
- Patient 1: A 10-year-old male with a mucoepidermoid tumor compromising the anterior carinal wall. Resection involved two distal tracheal rings and the first bronchial rings. Surgery was performed via right thoracotomy with veno-venous ECMO support. The patient was extubated postoperatively and remains disease-free after six years.
- Patient 2: A 2-month-old female with distal tracheal stenosis, complete obstruction of the right main bronchus, and secondary lung exclusion. Emergency surgery with veno-arterial ECMO support involved resection of the distal trachea and left bronchial ring, reinsertion of the upper lobar bronchus, and enlargement plasty of the intermediate bronchus. Right bronchial restenosis was later managed with dilation. One year later, the patient remains symptom-free.
- Patient 3: A former extremely premature female with prolonged intubation for two months, later diagnosed with 70% distal tracheal stenosis, spiral scarring of the carina and left bronchus, 80% left main bronchus stenosis, and 20% right main bronchus stenosis. Carinal and bronchial reconstruction was performed under bypass support, resulting in a trifurcated neocarina connecting the left main bronchus, intermediate bronchus, and right upper lobar bronchus. Bronchoscopic follow-up confirmed resolution of all stenoses and intact bilateral tracheobronchial anastomoses with no leaks or dehiscence.
Conclusion
Carinal pathology in pediatric patients is rare and technically demanding. Successful outcomes depend on individualized planning, advanced surgical techniques, and interdisciplinary management in specialized centers.
Keywords: Carinal reconstruction, ECMO support, bypass support, trachea stenosis, bronchus stenosis