Management of complete tracheal rings in a neonate with tetralogy of Fallot

Description 

A 3-day-old full-term female infant was postnatally diagnosed with tetralogy of Fallot with severe subpulmonary and pulmonary valve obstruction, ventricular septal defect with right to left shunt and patent ductus arteriosus (PDA). She was stable on room air with an intravenous prostaglandin infusion while awaiting surgical repair. On day 3 of life, she was found unresponsive with significant desaturation to 30%. Following successful bag-mask ventilation and recovery of her saturation, multiple attempts to intubate the patient yielded a grade I view (figure 1). However, 3.0, 2.5 or 2.0 endotracheal tubes were unable to be passed due to an obstruction immediately distal to the vocal cords (figure 2). Mask ventilation was maintained without difficulty between each attempt. Transthoracic echocardiogram was performed at bedside in order to confirm adequate pulmonary blood flow through the PDA. The patient was transported to the operating room with mask ventilation...

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