自体心包修复儿童主动脉瓣狭窄9例病例系列报告

目的：总结并分析以自体心包修复儿童先天性主动脉瓣狭窄的手术方法和早期预后。方法：纳入2013年7月至2015年6月在复旦大学附属儿科医院行自体心包主动脉瓣成形术的先天性主动脉瓣狭窄患儿,收集患儿的一般资料,围手术期情况,并发症,术前、术中、术后和随访时的超声心动图资料。结果：符合本文纳入标准的9例患儿进入本文分析,男6例,女3例,年龄4月龄至9岁。术前超声提示,三叶式和二叶式主动脉瓣分别为3例和6例;重度狭窄6例,中度狭窄1例,重度狭窄伴中度返流2例。9例均以自体心包再造或扩大主动脉瓣瓣叶。术后即刻与术前超声心动图比较：主动脉瓣最大跨瓣压差［（31.6±9.4）mm Hg vs（73.0±22.2）mm Hg, P=0.000］和主动脉瓣平均跨瓣压差［（15.8±18.3）mmHg vs （35.8±18.3）mmHg, P= 0.004］均下降。术后随访24～48（32±8）月,无死亡和再干预病例,未见严重不良事件,未见主动脉瓣重度狭窄或重度反流、升主动脉狭窄或扩张、主动脉瓣瓣环狭窄与扩张、瓣膜脱垂或瓣膜赘生物病例;3例患儿分别在随访18、24和12个月时出现瓣叶活动僵硬,瓣叶开放不完全。术后左室后壁厚径均呈下降趋势;末次随访时,8例患儿左室后壁厚径Z值（Z-LVPWd）均下降至正常水平（＜2）。结论：以自体心包修复主动脉瓣可改善先天性主动脉瓣狭窄患儿的血流动力学,手术风险低,术后早期疗效可,避免或延缓儿童主动脉瓣置换术,减少施行ROSS手术机会。     

儿童主动脉瓣瓣叶扩大成形术的近中期疗效分析

目的分析应用自体心包行主动脉瓣瓣叶扩大成形术治疗儿童主动脉瓣疾病的近中期效果。方法回顾性分析2017年9月至2021年6月在阜外华中心血管病医院行自体心包主动脉瓣成形术的26例主动脉瓣疾病(狭窄或关闭不全)患儿的临床资料, 收集近中期随访时资料, 比较术前和术后主动脉瓣最大跨瓣压差、主动脉瓣下反流面积、左心室舒张末期容积(LVEDV)和左心室射血分数(LVEF)等相关指标, 并采用配对t检验分析自体心包主动脉瓣扩大成形术的近中期疗效。结果 26例患儿手术均获得成功, 术后随访无死亡和严重并发症病例, 随访时间(22.96±6.45)个月。术后近中期主动脉瓣狭窄或狭窄合并轻中度关闭不全患儿中与术前主动脉瓣跨瓣压差比较, 术后1个月(t=7.85, P<0.05)、6个月(t=6.43, P<0.05)、1年(t=6.16, P<0.05)、2年(t=4.22, P<0.05)差异均有统计学意义;单纯主动脉瓣狭窄9例患儿随访结果, 术前舒张期主动脉瓣反流面积(8.87±3.57) cm2, 术后1个月、6个月、1年和2年主动脉瓣反流面积与术前比较差异均有统计学意义(...     

Doty法矫治小儿先天性主动脉瓣上狭窄的疗效

目的 总结Doty法矫治小儿先天性主动脉瓣上狭窄的临床疗效.方法 2009年1月至2013年6月,Doty法矫治小儿先天性主动脉瓣上狭窄12例,其中合并Williams综合征5例.其中男9例,女3例;年龄9个月～12岁[(5.3±4.2)岁];体质量7.5～ 32.0(11.5±5.3)kg.心脏超声和增强CT明确诊断,局限型9例,弥散型3例;跨主动脉瓣上收缩压差6.86 ～16.23(11.07±3.68) kPa,压差＞13.33 kPa者3例;合并左、右肺动脉分支狭窄3例,主动脉瓣二瓣化2例,主动脉瓣轻度返流2例,动脉导管未闭2例,轻度狭窄1例,主动脉瓣下膈膜1例,肺动脉瓣狭窄1例.1例二尖瓣中-重度关闭不全.12例患儿均在全麻体外循环下行Doty法矫治术,并处理合并畸形.结果 体外循环时间68～ 129(85±26) min;主动脉阻断时间43 ～68(51±16) min.术后早期无死亡,无严重低心排出量综合征;5例轻度ST段改变,3例偶发期前收缩;呼吸机应用7～58 h,心脏重症监护室治疗时间1 ～5 d;超声心动图检查提示跨主动脉瓣上收缩压差1.01 ～3.76(2.18±1.09) kPa;有效随访患儿11例,随访6个月～3年,无死亡,无头晕、心悸.除2例患儿外,其余残余压差均低于3.33 kPa.结论 Doty法治疗小儿先天性主动脉瓣上狭窄可获得满意的疗效.     

先天性心脏病伴气管狭窄或受压的诊治探讨

目的 探讨先天性心脏病伴气管狭窄或受压的诊断和治疗措施,以提高对气管狭窄的认识.方法 收集本院先心病伴气管狭窄或受压患儿41例,平均年龄14.6个月,体重7.8 kg.主要病种:室间隔缺损/肺动脉高压;法乐四联症肺动脉闭锁、肺动脉瓣缺如;主动脉缩窄伴室间隔缺损;右室双出口;肺动脉吊带等.9例患儿伴双主动脉弓、迷走锁骨下动脉.经胸部CT、气管造影和纤维支气管镜确诊:气管弥漫性狭窄9例,局限性狭窄16例,支气管狭窄7例,多发性狭窄伴支气管桥4例,气管软化5例.38例行体外循环心脏修补术,6例同时行气管狭窄纠治术(端端吻合术3例;自身气管片移植扩大2例;补片扩大1例).5例行气管切开术,用套管支撑狭窄段.结果 住院、近期死亡8例(19.50%).随访22例,平均(2.9±2.4)年.气管端端吻合及自身气管补片扩大者,气管通畅;补片修复者,肉芽组织增生再狭窄.带套管支撑者存活4例,分别于术后3个月、1年、2年、8年拔除气管套管.狭窄未处理者,狭窄段内径与气管整体生长成比例狭窄.结论 先天性心脏病伴气管狭窄诊断需及时,重度气管狭窄与心脏手术Ⅰ期矫治,以滑片吻合术,自身气管片移植术为好.轻、中度狭窄则等待其成长是最好策略.     

手术治疗肺动脉吊带合并气管狭窄15例的疗效分析

目的探讨先天性肺动脉吊带合并气管狭窄的手术治疗经验及体会。方法 2010年7月至2016年10月,共计手术治疗儿童先天性肺动脉吊带15例,回顾性分析其手术治疗方法及预后。结果患儿手术时平均年龄1岁3个月,均体外循环下行异位左肺动脉移植术,气管据术中狭窄程度做不同处理:未处理6例、滑动成形5例、狭窄段切除端端吻合2例、气管纵行切开及心包补片增宽2例;手术死亡2例,死亡率为13.3%:其中滑动成形死亡1例、气管心包补片增宽死亡1例。结论婴幼儿先天性肺动脉吊带极易合并气管狭窄,气管狭窄手术修复较为困难,部分患儿单纯左肺动脉移植可带来满意疗效,重度长段气管狭窄需行气管滑动成形手术。     

小儿主动脉狭窄的心导管及心血管造影检查之评价

为评价心导管及心血管造影检查对小儿主动脉狭窄的诊断价值。应用左右心导管检测心室和大血管压力及血氧饱和度,左、右室及升主动脉造影显示狭窄部位和合并畸形,并以造影与超声心科检查作比较,结果：主动脉瓣上狭窄２５例,８例伴有外周体循环动脉狭窄。１６例伴有外周肺动脉狭窄,３例存在冠状动脉病变;主动脉瓣狭窄４３例,１８例单纯主动脉瓣供穿行球囊瓣膜成形术;主动脉瓣下狭窄４８例,４６合并其他先天性心脏病,仅２例为单纯主动脉瓣下狭窄,说明先天性主动脉瓣上及瓣膜狭窄时心导管及心血管造影仍很有必要,单纯主动脉瓣下狭窄,可不必作心导管和心血管造影。     

基质金属蛋白酶-2与-9在先天性二叶型主动脉瓣中的表达及意义

目的检测基质金属蛋白酶(MMPs)MMP-2、MMP-9在先天性二叶型主动脉瓣中的表达,探讨MMP-2、MMP-9在先天性二叶型主动脉瓣病变中的作用。方法选取因先天性二叶型主动脉瓣伴主动脉瓣狭窄(AS)和(或)主动脉瓣关闭不全(AI)行主动脉瓣置换术切取的儿童二叶型主动脉瓣瓣膜为研究组(n=12,男11例,女1例,年龄10～18岁,平均16.7岁,单纯AS3例、单纯AI8例、AS-AI1例),病例来源为2003-01—2005-12华中科技大学同济医学院同济医院住院患儿;以同期性别、年龄相近,无心血管系统及胶原系统疾病、意外死亡患儿的正常三叶型主动脉瓣(n=8,男6例,女2例,年龄在1～17岁之间,平均年龄9.1岁)为对照组,采用HE染色和免疫组织化学方法,观察先天性二叶型主动脉瓣组织学变化,对MMP-2、MMP-9蛋白质表达行半定量分析。结果正常主动脉瓣可见MMP-2、MMP-9低水平表达,MMPs在先天性二叶型主动脉瓣组、对照组表达的平均灰度值:MMP-2分别为(68.31±6.91)、(107.31±23.39),(P<0.05);MMP-9分别为(64.47±3.98)、(116.28±6.99),(P<0.05);先天性二叶型主动脉瓣组MMP-2、MMP-9表达较正常对照组显著性增强。结论先天性二叶型主动脉瓣中MMP-2、MMP-9表达水平增高,MMP-2、MMP-9可能参与先天性二叶型主动脉瓣细胞外基质(ECM)降解、重构,导致主动脉瓣结构和功能障碍,在先天性二叶型主动脉瓣病变的发生发展中起重要作用。     

肺动脉瓣狭窄合并房间隔缺损的介入治疗效果分析

目的 探讨儿童先天性肺动脉瓣狭窄合并房间隔缺损的介入治疗方法和临床随访效果.方法 27例肺动脉瓣狭窄合并房间隔缺损的患儿,同时进行肺动脉瓣成形术和房间隔缺损封堵术,术后即刻、1周、3个月、6个月行超声心动图检查,随访其临床效果.结果 27例经皮球囊肺动脉瓣成形术均获得成功,术后即刻测量跨肺动脉瓣压力阶差由术前的(79±62)mmHg降至(49±36)mmHg,术后超声心动图随访过程中跨肺动脉瓣压力阶差持续下降.超声心动图测量房间隔缺损直径为3.4～24.6(11.7±6.9)mm,选择封堵器的直径为8～32(14.6±8.7)mm,27例中有24例成功进行封堵.结论 介入治疗肺动脉瓣狭窄并房间隔缺损是一种安全可靠的方法,严格掌握适应让,特别是房间隔缺损的适应证,可取得良好的临床效果.     

先天性心脏病外科术后残余病变的介入治疗

目的 探讨先天性心脏病(先心病)外科术后残余病变介入治疗的可行性.方法 1995年2月 - 2010年12月收治98例先心病外科术后残余病变患儿,年龄9个月～ 16岁,平均(5.5 ± 3.8)岁.对有先心病手术残余漏患儿选择不同封堵器封堵治疗,对有血管狭窄的患儿做球囊扩张或支架植入治疗.结果 70例先心病手术残余漏患儿选择封堵器成功封堵.15例肺动脉分支狭窄者,12例选择NuMED CP覆膜支架植入,左、右肺动脉压力差(ΔP)分别降为4和5 mmHg,另3例因年龄小选择球囊扩张,但术后ΔP仅部分下降10 ～ 15 mmHg左右.6例主动脉残余局限性狭窄,其中5例球囊扩张,1例无效,4例ΔP下降至(19 ± 6.7)mmHg;另1例,用NuMED CP支架植入后ΔP仅3 mmHg.其他血管狭窄者选球囊扩张,ΔP均降至正常范围.结论 对于部分先心病外科术后残余病变,可以通过介入治疗完成,避免了再次开胸手术.     

小儿室间隔缺损合并主动脉瓣关闭不全的外科治疗

小儿先天性心脏病中室间隔缺损(VSD)合并主动脉瓣关闭不全(AI)引起的血流动力学改变可导致严重的心功能损害及重度肺动脉高压,外科手术可同期处理室缺及主动脉瓣病变,从而取得优良的治疗效果.目前治疗主动脉瓣关闭不全的主要手术方式是通过主动脉根部切口行成形术或置换术.通过总结我院心外科自2008年5月至2011年1月2年多来1 600例小儿室缺患儿中,22例大室缺(室缺直径＞10 mm)合并主动脉瓣关闭不全患儿(比例约1.4％)的手术治疗发现:通过大的室缺行主动脉瓣成形术可以取得良好的临床效果,且手术减少了主动脉切口及其带来的并发症,手术得到简易化.     

肺动脉环缩术在儿童复杂先天性心脏病中的应用

目的 探讨肺动脉环缩术在儿童复杂先天性心脏病中的应用经验,并对手术效果进行评价.方法 回顾性分析2002年1月～2007年3月进行的32例肺动脉环缩术.男22例,女10例,手术年龄平均9.2个月,体重平均6.1 kg.肺动脉环缩后肺动脉周径平均(28.0±4.1)mm,术后估测环缩近远端压差(43.7±9.0)mmHg.结果 围术期死亡1例,2例患儿再次调整环缩.4例患儿出现围术期并发症.31例患儿随访1个月～5年,22例患儿进行Ⅱ期手术.结论 肺动脉环缩术可限制肺血过多,锻炼左心室,为Ⅱ期施行双心室矫治及双向腔肺分流术赢得时机.     

Echocardiographic Follow-Up of Children with Supravalvular Aortic Stenosis

This study evaluates the course of supravalvular aortic stenosis (SVAS)-associated right ventricular outflow tract (RVOT) obstruction and the results of surgery in children. We reviewed the medical records of 24 patients diagnosed with SVAS at initial echocardiographic examination or during the following period of RVOT obstruction. Very mild SVAS was defined as a transvalvular Doppler peak systolic instantanous gradient (PSIG) less than 25 mmHg, mild stenosis as 25–49 mmHg, moderate stenosis as 50–75 mmHg, and severe stenosis as more than 75 mmHg. The mean age of the patients was 3.1 ± 2.9 years (range, 7 days to 12.7 years), and 18 of the patients (72%) were male. Fifteen patients had Williams’ syndrome. Seventeen patients (71%) were followed for a mean of 5.2 ± 3.8 years (range, 7 months to 13.5 years). Among 17 patients with complete follow-up records, 1 (6%) had very mild, 5 (29%) mild, 3 (18%) moderate, and 3 (18%) severe aortic stenosis at initial echocardiographic examination. In a newborn patient with mild pulmonary valvular stenosis. SVAS became evident after 2 months and progressed rapidly. Supravalvular aortic stenosis was very mild in 4 patients (23%), mild in 3 (18%), moderate in 3 (18%), and severe in 7 (41%) at last echocardiographic examination. Of 17 patients who were followed, 11 (65%) had RVOT obstruction at initial echocardiographic examination. RVOT obstruction disappeared in 5 patients, regressed in 1 patient, and appeared in 1 patient over the follow-up period. Four patients underwent operation. It appears reasonable that patients with very mild and mild stenosis should be followed medically every 1 or 2 years and patients with moderate stenosis once a year. Newborns with SVAS should be followed for rapid progression of SVAS. In some patients, RVOT obstruction may disappear, and SVAS may develop in others with RVOT obstruction. Patients with RVOT obstruction (at the valvular, supravalvular, or peripheral pulmonary arterial level) should be evaluated carefully for development of SVAS at follow-up.     

非体外循环主动脉缩窄根治术治疗儿童主动脉缩窄的疗效分析

目的 评价儿童左后外侧入路非体外循环主动脉缩窄根治术的治疗效果. 方法 回顾性分析重庆医科大学附属儿童医院2010年2月至2019年8月收治的经左后外侧入路非体外循环下行主动脉缩窄根治术的69例患者临床资料,其中男童38例,女童31例,年龄10.4(4.4,53.2)个月,体重8.0(5.0,14.5)kg.根据手术时...     

Balloon valvuloplasty for congenital heart disease: Immediate and long-term results of multi-institutional study

BACKGROUND AND OBJECTIVES: Several studies have been reported in Japan. However, the reports consist of small series at individual institutions. We evaluated the immediate to long-term results of balloon valvuloplasty (BVP) of congenital pulmonary and aortic stenosis at multi-institutions in Japan. METHODS AND RESULTS: Immediate and follow-up data were obtained from eight institutions in Japan. In our series of 172 cases of pulmonary valvuloplasty excluding critical pulmonary stenosis, the mean pressure gradient decreased immediately after BVP from 61+/-27 mmHg to 28+/-20 mmHg and the reduced gradient continued at follow-up in most cases. The BVP for critical pulmonary stenosis could be accomplished in 35 of 39 patients. The mean right ventricular systolic pressure decreased from 102+/-29 mmHg to 62+/-23 mmHg. One of them required the surgical operation for perforation of the right ventricular outflow tract. In BVP for congenital aortic valvular stenosis of 77 cases excluding critical aortic stenosis, the mean pressure gradient decreased immediately after BVP from 68+/-24 mmHg to 34+/-23 mmHg. Thirty-one cases (55%) were free from any interventions in long-term follow-up. The BVP for critical aortic stenosis was performed in 29 neonates. The overall mortality rate was 34% and 24% of the patients required repeat intervention. The remaining 42% was free from any interventions. CONCLUSIONS: Balloon valvuloplasty for congenital pulmonary valvular stenosis is a safe and effective procedure and the initial treatment of choice. In spite of an occasional major complication, BVP for critical pulmonary stenosis is effective in many infants. Balloon aortic valvuloplasty is palliative. However, this procedure has the efficacy in deferring the surgical intervention. Balloon valvuloplasty for neonatal critical aortic stenosis is a useful method to recover from serious conditions.     

食管超声引导下经胸镶嵌治疗婴幼儿房间隔缺损合并肺动脉瓣狭窄

目的 探讨单纯食管超声(TEE)引导下经胸镶嵌治疗婴幼儿房间隔缺损合并肺动脉瓣狭窄的有效性和安全性.方法 回顾2014年3月至2016年9月我科收治的继发孔房间隔缺损合并中重度肺动脉瓣狭窄患儿29例,其中男19例,女10例,年龄(3～18)个月,平均7.5个月,体重(5.5～11.4)kg,平均8.2 kg.术前经胸超声检查及术中经食管超声检查明确房间隔缺损均为中央型,直径(9.6±1.4)mm,所选择封堵伞的型号为大于房缺最大径2～4mm的封堵伞.合并肺动脉瓣狭窄其跨瓣压差(78.6±9.4)mmHg,肺动脉瓣瓣环直径(11.1±1.6)mm,所选择球囊直径为肺动脉瓣环直径1.2～1.4倍,反复扩张2～3次.全身麻醉气管插管,经胸剑突小切口,单纯食管超声引导下同期行房间隔缺损封堵及肺动脉瓣球囊扩张.术后3个月门诊经胸超声随访.结果 全组29例房间隔缺损封堵及肺动脉瓣球囊扩张均成功,术中及术后随访未出现并发症.术后即刻测压(18.3±9.3)mmHg,术后较术前明显下降(P＜0.001).术后即刻超声提示房间隔水平未见分流.术后3个月随访,房间隔封堵器位置正常,无残余分流,肺动脉瓣跨瓣压差为(19.9±5.8)mmHg,与术前相比差异有统计学意义(P＜0.001).29例病例随访3～33个月,所有患儿生长发育良好,房间隔水平无分流,肺动脉瓣跨瓣压差平均为(17.4±6.9)mmHg,均在40mmHg以内,封堵器位置良好,其中微小量反流7例,少中量反流1例,余21例患儿未见肺动脉瓣反流.结论 食管超声引导下经剑突微创小切口镶嵌治疗婴幼儿心脏复合畸形近期安全有效,可达到传统体外循环手术的治疗效果,避免体外循环带来的创伤,但对其远期疗效的评估仍需进行长期随访.     

儿童复杂先天性心脏病肺动脉环缩术后二期手术时机的探讨

目的探讨儿童复杂先天性心脏病肺动脉环缩术后最佳二次手术时机,并对二期手术效果进行评价。方法2002年1月至2007年12月,本中心对32例儿童复杂先天性心脏病实施肺动脉环缩术。32例超声心动图估测环缩近远端压差平均为43.7±9.0mm Hg。22例实施二期手术患儿中,男18例,女4例,年龄15.5±21.9个月。二期手术前经皮血氧饱和度为82.7%±9.1%。术前肺动脉压力为19.5±6.5mm Hg。结果二期手术距第1次手术时间平均7.6±10.8个月（10d至40个月）。其中6例行大动脉调转术,8例行双向腔肺分流术,8例行其他双心室修补术。1例围术期死亡,5例发生围术期并发症。术后经皮平均血氧饱和度为92.0%±8.7%（76%～100%）。按二期手术方法分为单心室修补组、完全性大动脉转位组和双心室修补组,2次手术间隔时间分别为3.9±3.6个月、5.7±9.3个月和12.9±14.1个月。结论肺动脉环缩术后二期手术需根据原发病及进行肺动脉环缩的目的选择个体化二期手术方案和时机,以创造最佳手术条件,减轻肺动脉环缩姑息手术带来的并发症。     

Percutaneous balloon aortoplasty for restenosis after extended aortic arch anastomosis for type B interrupted aortic arch

A 4-month-old boy underwent a percutaneous balloon aortoplasty for restenosis after extended aortic arch anastomosis for type B interrupted aortic arch (IAA). Balloon aortoplasty resulted in a decrease in the peak systolic pressure gradient across the obstructive segment from 84 mmHg to 19 mmHg and in an increase in diameter from 2.5 mm to 4.3 mm. No complications related to the procedure were observed. We assume that balloon aortoplasty can be effective and safe for relieving postoperative aortic obstruction associated with IAA.     

Slide方法在小儿先天性气管狭窄的应用

目的 总结Slide方法纠治长段气管狭窄的手术疗效.方法 2001年8月至2010年10月,手术纠治先天性气管狭窄21例.手术年龄28 d至8.6岁,平均(21.9±27.1)个月,体重4.2～22.5 kg,平均(9.65±4.24)kg,除2例分别为纵隔肿瘤和气管外伤所致气管短段狭窄外,其余19例均伴有先天性心脏病.根据气管狭窄长度,分为短段气管狭窄9例,长段气管狭窄12例.所有病例均在低温体外循环下行先天性心脏病纠治术,同时行气管狭窄处理.近期8例均采用Slide方法.结果 21例先天性气管狭窄手术死亡2例.1例早期采用人工材料修补,术后3个月出现肉芽,放弃治疗死亡.1例长段气管狭窄采用Slide方法,术后3周出现气管内肉芽,经多次球囊扩张、激光烧灼均无效,死亡.余19例长期随访2个月至8年,气管狭窄症状消失,CT复查效果满意,无一例再次手术.结论 Slide气管成形术采用自体的气管组织重建气道,吻合口牢固稳定,而且保持了正常的气管内膜,保证术后气管内壁的细胞功能和良好生长.是长段气管狭窄的最佳手术方法.由于本组病例较少,还需要定期随访,观察长期疗效.

Abstract：

Objective To evaluate slide tracheoplasty for congenital tracheal stenosis. Methods Between August 2001 and October 2010, twenty-one patients with congenital tracheal stenosis were repaired. The operative age was 28d～8. 6y (mean 21.9 ± 27. 1m) and the weight was 4. 2～22. 5kg (mean 9. 65 ± 4.24 kg) . Except for one case of mediasternal tumour and another one of tracheal trauma, all the restothers had congenital heart disease. There were 9 patients with short tracheal stenosis and 12 patients with long segment tracheal stenosis. The congenital heart disease were repaired underwent low temperature and cardiopulmonary bypass, and the tracheal stenosis were corrected simultaneously. Nine patients with long segment tracheal stenosis were repaired by slide tracheoplasty. Results There was two death in this group. One patient with right and left broncheal stenosis was repaired by synthetic patch. He succumbed 3 months later due todied of granulation tissue on the patch. Another patient with long segment tracheal stenosis was repaired by slide tracheoplasty, who also died from granulation tissue. All other 19 patients were uneventful. These patients were followed up from 2 month to 8 years, there were no complication. CT scan shows that the tracheal anastomosis was patent withand no any stenosis. Conclusions The slide tracheoplasty was used by autologous material,maintaining its contour and function of respiratory epithelium, and keeping its growth. The slide tracheoplasty is best way for correction of long segment tracheal stenosis. Long term follow up is required.