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[Aortopexy for tracheomalacia in infants and children]
I Vinograd1, B Klin, A Silbiger
1Dept. of Pediatric Surgery, Dana Children's Hospital, Sourasky-Tel Aviv Medical Center.
Insights
Aortopexy effectively treats severe tracheomalacia in infants and children, significantly improving respiratory symptoms. This surgical technique involves lifting the aortic arch to the sternum, offering relief for severe breathing difficulties.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Respiratory Medicine
Context:
- Tracheomalacia, a condition causing tracheal collapse, presents significant respiratory challenges in infants and children.
- Diagnosis is typically confirmed via rigid bronchoscopy, observing tracheal collapse during forced expiration.
- Surgical indications include cyanotic spells, recurrent pneumonia, and extubation difficulties.
Purpose:
- To evaluate the efficacy of bronchoscopy-guided aortopexy for treating severe tracheomalacia in pediatric patients.
- To assess the long-term outcomes and complications associated with this surgical intervention.
Summary:
- Twenty-eight infants and children underwent aortopexy for tracheomalacia between 1985 and 1998.
- The procedure involved suspending the great vessels anteriorly to the sternum using sutures.
- Significant respiratory improvement was observed in 21 patients; 4 experienced failed aortopexy, with some requiring additional interventions or tracheostomy for co-existing conditions like laryngomalacia.
Impact:
- Aortopexy provides a viable surgical solution for severe tracheomalacia, leading to substantial relief from respiratory distress in most pediatric patients.
- Long-term follow-up demonstrated that 25 out of 28 patients were free of residual respiratory symptoms.
- The study highlights aortopexy as a successful treatment for severe tracheomalacia, improving quality of life for affected children.
Abstract:
During the past 12 years (1985-1998), 28 infants and children were operated on here for tracheomalacia. The diagnosis was made in all using rigid bronchoscopy. During the examination the infants breathed spontaneously, but the trachea collapsed on forced expiration. Indications for surgery were repeated cyanotic spells ("dying spells") in 22, recurrent pneumonia, and inability to extubate (in 8). In 11 there were more than 1 indications. Age at surgery was from 7 days to 3 years (average 11.7 months). All 28 children underwent bronchoscopy and guided aortopexy via a left-third intercostal approach. The ascending aorta and aortic arch (and in 6 the proximal innominate artery as well) were lifted anteriorly, using 3-5 non-absorbable sutures (5.0). The sutures were placed through the adventitia of the great vessels and then passed through the sternum. Respiratory distress was significantly improved in 21. Another 2 required external tracheal stenting with autologous rib grafts, and in 1 other an internal Palmaz stent was introduced for tracheal stability. In 4 aortopexy failed, 1 of whom had tracheobronchomalacia throughout, and another 3 had laryngomalacia which required tracheostomy to relieve the respiratory symptoms. Postoperative complications were minor: pericardial effusion in 1 and relaxation of the left diaphragm in another. 1 infant subsequently died, of unknown cause 10 days after operation, after having been extubated on the 1st postoperative day. On long-term follow-up (6 months to 12 years) 25 were found free of residual respiratory symptoms and 3 remained with a tracheostomy. Thus, infants and children with severe tracheomalacia associated with severe respiratory symptoms, can be relieved by bronchoscopic guided suspension of the aortic arch to the sternum.