Subglottic stenosis in children undergoing repair of congenital heart defects.

OBJECTIVES

To examine the incidence of subglottic stenosis in children with congenital heart disease undergoing surgical repair and the contributing factors to such a complication.

DESIGN

A retrospective chart review.

SETTING

Tertiary care children's hospital heart center.

PATIENTS: Children with congenital heart disease undergoing cardiac surgical repair and presenting with subglottic stenosis in the postoperative period.

MEASUREMENTS AND MAIN

RESULTS

The authors reviewed their practice for a 4-year period (2002-2005) and identified 17 of 809 children <2 years old with congenital heart disease diagnosed with significant subglottic stenosis in the postoperative period. The incidence was 2.3% in children <1 year old and 2.1% in children <2 years old; the overall incidence was 1.08% in all children <18 years old (17/1,572) undergoing cardiac surgical repair in the same time period. Intubation duration of <24 hours had an incidence of 0.58% compared with 16% in those intubated for >96 hours. The common use of cuffed endotracheal tubes (783/809 children <2 years) did not result in an increased risk of subglottic stenosis in the authors' practice.

CONCLUSION

Subglottic stenosis is an uncommon complication in children undergoing surgical repair of congenital heart defects. The most important risk factors are younger age and prolonged postoperative ventilation. Early diagnosis, referral, and intervention resulted in a favorable outcome in most of the authors' patients.