WOFAPS 2025 8th World Congress of Pediatric Surgery

Diana Romero, Carolina Zuluaga, Martha Velazco, Laura Suárez, Federico Núñez, Miguel Sánchez, Otto González, Maria Eugenia Gamma, Paul Yuseph Benavides, Emily Angélica Villanueva

Clínica Shaio

Introduction

Complex congenital airway and vascular anomalies present significant diagnostic and surgical challenges, particularly in neonates with syndromic associations. Precise anatomical understanding is essential for successful corrective surgery. Three-dimensional (3D) anatomical models can enhance preoperative planning and improve surgical outcomes in selected cases.

Case Presentation

A male neonate weighing 1,970 grams at birth, diagnosed with VACTERL association due to anorectal malformation and a horseshoe kidney, underwent colostomy at 24 days of life. During orotracheal intubation for the procedure, significant difficulty was encountered, requiring dilation and placement of a size 2.5 uncuffed endotracheal tube. Postoperatively, the infant developed progressive stridor, episodes of desaturation, and feeding difficulties, raising suspicion of a congenital airway malformation.

Bronchoscopy with intraoperative bronchography revealed stenosis of the cervical, middle, and distal trachea, with preservation of the first and second tracheal rings, as well as congenital bronchial stenosis due to an anomalous origin of the right main bronchus. Angio-CT with 3D reconstruction confirmed a pulmonary artery sling, agenesis of the right upper lobe, hypoplasia of the right middle and lower lobes, and rightward mediastinal shift. Given the complexity of the anomalies, 3D-printed anatomical models were created to assist with surgical planning.

The patient successfully underwent slide tracheoplasty and tracheal translocation with intraoperative extracorporeal membrane oxygenation (ECMO) support for 2 hours and 40 minutes. Follow-up bronchoscopy demonstrated an intact anastomosis with no dehiscence and patent origins of both main bronchi, without evidence of tracheal or bronchial malacia.

Conclusion

This case highlights the value of 3D anatomical models in preoperative planning for neonates with complex tracheovascular anomalies. When meticulously planned, slide tracheoplasty and tracheal translocation can be performed safely, even in low-weight patients. A multidisciplinary approach, combined with advanced imaging and modeling techniques, plays a critical role in achieving successful surgical and airway reconstruction outcomes.