Implications between Segmental and Lobar Tracheobronchus in Congenital Heart Disease: A 12-Year Retrospective CT Analysis

Mohamad Yanuar Amal^1,2Shyh Jye Chen^3*

• ¹Rumah Sakit Dr Cipto Mangunkusumo, Central Jakarta, Indonesia
• ²Universitas Indonesia, Depok, Indonesia
• ³National Taiwan University Hospital, Taipei City, Taiwan

Objectives: This study aims to evaluate the prevalence and anatomical patterns of tracheobronchial anomalies and to analyze their associations with different types of congenital heart disease (CHD) using retrospective CT data. Introduction: Tracheobronchial anomalies, including variations in the branching patterns of the trachea and bronchi, are relatively rare but clinically significant. These anomalies, often associated with congenital heart disease (CHD), can complicate respiratory function and airway management. Despite their low prevalence, early identification and understanding of these anatomical variations are needed for improving patient outcomes. Methods: This retrospective study was conducted at the National Taiwan University Hospital whose patients underwent Computed Tomography (CT) imaging from December 2012 to February 2024. Inclusion criteria were strictly defined to focus on patients diagnosed with a lobar or segmental tracheal bronchus anomaly, as identified during their initial CT scan. Results: Among 356 patients diagnosed with tracheobronchial anomalies, 223 had concurrent CHD. The study found a significant association between tracheobronchial anomalies and CHD, particularly with conditions like right-sided aortic arch and pulmonary atresia. Additionally, the presence of persistent left superior vena cava (PLSVC) was notably higher in patients with CHD. Discussion: The study accentuates the importance of early detection tracheal bronchus anomalies, particularly in patients with CHD. Early detection through advanced imaging techniques is critical for minimizing complications. This study supports the "space availability" hypothesis regarding the embryological development of these anomalies. Moreover, the significant association between tracheal bronchus and conditions such as pulmonary atresia and right-sided aortic arch suggests a shared embryological pathway. Conclusion: Tracheobronchial anomalies are clinically significant, particularly in the context of congenital heart disease (CHD). Timely identification, coupled with a multidisciplinary approach, is crucial for enhancing patient outcomes and reducing complications. Future research should focus on genetic and environmental influences that contribute to the development of these conditions.