Pericardial flap aortopexy for tracheomalacia

Tracheomalacia is frequently associated with esophageal atresia and vascular compression of the thoracic viscera. Suture aortopexy, as first described by Gross, has become the most commonly used surgical procedure for alleviating the symptoms of tracheomalacia. External stenting, implantation of cartilage graft, and tracheal resection have been tried in severe cases not amenable to aortopexy. A standard aortopexy was attempted in an infant who had undergone division of the posterior portion of a double aortic arch. Because of very tight posterior attachments of the mediastinal structures, the aortic arch could not be brought up to the sternum without undue tension. A 3 x 2 cm flap of pericardium was formed, based at the aortic root. The free end was then sutured to the undersurface of the sternum, thereby pulling the aorta toward the sternum under gentle, controlled tension. The patient was easily extubated and has remained symptom free. Pericardial flap aortopexy is a relatively simple procedure with minimal risk to the aorta or trachea. It may be the preferred initial procedure in the surgical management of tracheomalacia.