Airway abnormalities in Children with Congenital Heart Disease

Eg Kah Peng
University Malaya Medical Centre, Kuala Lumpur, Malaysia

Airway abnormalities, both congenital and acquired, are significant yet often overlooked issue in children with congenital heart disease (CHD). Congenital abnormalities include tracheomalacia, bronchomalacia, complete tracheal rings, and vascular airway compression due to aberrant vessels or cardiomegaly. Acquired airway issues may result from prolonged intubation, post-surgical scarring, or recurrent respiratory infections. The close anatomical relationship between the heart and airways in infants and young children predisposes this population to respiratory compromise, particularly when cardiovascular structures are enlarged or abnormally positioned. Clinical manifestations range from stridor and wheezing to persistent cough, recurrent pneumonia, and difficulty in ventilator weaning. These respiratory symptoms are sometimes misattributed solely to cardiac dysfunction, leading to delayed diagnosis. Comprehensive evaluation using flexible bronchoscopy or imaging modalities is essential to accurately characterise the nature and severity of airway involvement. Management strategies depend on the underlying cause and severity and may include conservative observation, medical therapy or surgical correction. Early identification and a multidisciplinary approach—integrating cardiology, pulmonology, otolaryngology, and cardiothoracic surgery—are critical for optimal outcomes. Recognising and addressing airway abnormalities in children with CHD is crucial not only for respiratory health but also for improving overall clinical stability and long-term quality of life.