Thoracoscopic aortopericardiosternopexy for severe tracheomalacia in toddlers

Aortosternopexy from a left anterolateral thoracotomy is the procedure of choice in severe tracheomalacia. The authors report an alternative technique of modified thoracoscopic aortopericardiosternopexy.

Thoracoscopy under mild CO2 insufflation (insufflation pressures 4 to 6 mm Hg) provides excellent access without selective intubation. The importance of visualizing the phrenic nerve, mobilization of the thymus without disrupting its vascular supply, and intraoperative bronchoscopy is stressed. The technique of passing the needle through the sternum and back is shown. In long segment tracheomalacia, not only the ascending aorta, but also the innominate artery and base of the pericardium are fixed to the sternum, and the effect is monitored by intraoperative bronchoscopy.

This technique was dramatically successful in a 4-year-old boy with long segment tracheomalacia and as a redo procedure in a 2-year-old girl after failed open aortopexy.

Thoracoscopic aortopexy seems to be as effective as open aortopexy.