SL Lee, NS Tsoi, YF Cheung, MP Leung

Airway problems may complicate the natural and surgical history of infants and children with congenital heart disease. Flexible bronchoscopy was performed in 40 patients with known congenital heart disease for evaluation of their airways. Seventeen patients had an acyanotic heart lesion, two with vascular anomalies and the remainder had cyanotic heart disease. Eighteen patients underwent operation which included 5 palliative procedures either pulmonary artery banding or shunt operation. The indications for bronchoscopy were

1. persistent or recurrent atelectasis, pneumonia or unilateral chest hyperinflation (n=23);
2. stridor (n=7);
3. ventilator dependency (n=4);
4. haemoptysis (n=3);
5. others (n=3).

Airway abnormalities were identified in 36 cases. The majority involved airway compression (n= 27). The left main stem bronchus alone was involved in 11 cases and the trachea in 5 cases. The right middle lobe bronchus was affected in 4 cases, 3 of which also had compression of the left main stem bronchus. There were 3 cases with extensive disease including the trachea and both main stem bronchi. Other bronchi were less frequently affected. In addition, tracheomalacia or bronchomalacia was noted in 4 cases with compression and occurred alone in 2 cases. Other abnormalities identified include laryngomalacia, subglottic stenosis, high take off right upper lobe bronchus, vocal cord paralysis and choanal stenosis. The clinical symptoms could be explained by the structural lesion in 31 of the cases. There was no significant complication of the procedure.

We conclude that flexible bronchoscopy is a useful and safe tool in the evaluation of airway abnormalities in patients with congenital heart disease. The left main stem bronchus is the commonest site of airway compression in our series.