Temporary closure of congenital tracheoesophageal fistula with Fogarty catheter.

INTRODUCTION Congenital tracheoesophageal fistula (TEF) is a common anomaly, occurring in one of every 2,500 live births. Greater than 90% of cases involve esophageal atresia (EA). The most common form of TEF with EA is the upper esophagus ending as a blind pouch and TEF connecting to distal esophagus a few millimeters above the carina. The exact cause is not yet completely understood. In recent years, the survival rate of the patients with TEF improved up to 90% due to advances in neonatal intensive care, nutritional support, and newborn anesthesia. However, in rare cases, persistent aspiration and recurrent pneumonia caused by the existing fistula induce poor medical conditions, despite intensive care and support, disabling the neonates to withstand corrective surgery performed under general anesthesia for several hours. For these patients, it is very important to allow sufficient time to recover lung function and improve their medical condition. The Fogarty catheter, developed by Dr. Thomas J. Fogarty in 1963, is a type of catheter that is used for various medical applications including removal of thrombi or emboli from blood vessels, or removal of stones from the urinary tract and gall bladder. The Fogarty catheter includes a small inflatable balloon at the catheter tip. Once the catheter has been inserted and placed, the balloon is inflated with air or a sterile fluid. It has been used to seal off various fistulas, including carotid cavernous fisulta, arteriovenous fistula, and bronchopleural fistula. We conceived the idea that the ballooning of a Fogarty catheter can provide durable blockage of the fistula opening for the temporary separation of the airway and gastrointestinal (GI) tract. Here, we present our experience with bronchoscopic insertion of a Fogarty catheter for temporary occlusion of TEF to facilitate ventilation and medical care until corrective surgery of the anomaly.