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Case report: Use of two balloon-tipped catheters during thoracoscopic repair of a type C tracheoesophageal fistula in a neonate

[Présentation de cas : Utilisation de deux cathéters à ballonnet pendant la réparation thoracoscopique d’une fistule trachéo-oesophagienne de type C chez un nouveau-né.]

From the Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, SAR, PRC.

Address correspondence to: Dr. Anthony Ho, Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR. Phone: 852 2632 2735; Fax: 852 2637 2422; E-mail: hoamh{at}cuhk.edu.hk

Purpose: To describe a novel airway management technique for thoracoscopic repair of a type C tracheoesophageal fistula (TEF) in a neonate.

Clinical features: A full-term neonate with a type C TEF presented for thoracoscopic repair. The fistula was at the level of the carina, making its isolation from positive pressure ventilation using traditional techniques difficult. In addition, non-ventilation of the right lung was required. The use of two Fogarty type balloon-tipped embolectomy catheters placed alongside the endotracheal tube successfully achieved the goal of blocking ventilation of the fistula and the right lung. The use of fibreoptic bronchoscopy greatly facilitated placement of the blockers. The patient made an uneventful recovery.

Conclusion: Placing two balloon-tipped blockers, one in the TEF and the other in the right mainstem bronchus, is a viable technique for thoracoscopic fistula repair when the fistula is at or very close to the level of the carina.