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Thoracoscopic aortopexy to treat severe tracheomalacia in children. Cases report
Carlos García-Hernández1,2, Lourdes Carvajal-Figueroa1,2, Cristian Archivaldo-García1,2
1Departamento de Cirugía Pediátrica, Hospital Infantil Privado. Ciudad de México, México.
Insights
Thoracoscopic aortopexy offers a safe and effective solution for severe tracheomalacia in infants. This minimally invasive approach improves tracheal space and reduces life-threatening events in young children.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Respiratory Medicine
Background:
- Severe tracheomalacia presents a significant challenge in pediatric care, often leading to life-threatening respiratory distress.
- Conventional treatments may be invasive or less effective for complex cases.
Observation:
- Three infants (3, 9, 12 months) with severe tracheomalacia and dependence on mechanical ventilation were treated.
- Diagnostic workup included bronchoscopy and thoracic angiotomography to confirm diagnosis and rule out extrinsic compression.
Findings:
- A left thoracoscopic aortopexy was successfully performed with intraoperative bronchoscopic monitoring.
- Significant improvement in tracheal diameter and airway patency was observed post-surgery.
- Patients experienced a reduction in respiratory events and ventilator dependence, with sustained improvement during follow-up.
Implications:
- Thoracoscopic aortopexy is a viable and effective minimally invasive surgical option for severe pediatric tracheomalacia.
- This technique can improve respiratory outcomes and quality of life for affected children.
- Further research can explore long-term efficacy and broader application in pediatric airway management.
Objective:
To present our experience in the treatment of the severe tracheomalacia by thoracoscopic approach, as well as its diagnostic methodology, surgical technique, post-operatory evolution and complications.
Clinical Cases:
From 2016 to 2017, three patients, 3, 9 and 12 months old, were treated. They showed multiple near sudden death events and had an absolute dependence to assisted ventilation. Pre-operatory bronchoscopy evinced tracheal severe malacia. Thoracic angiotomography discarded other extrinsic tracheal compression causes. A left thoracoscopic aortopexy was practiced with a bronchoscopical trans-operatory control; with improvement in tracheal space. Just one patient is still awaiting cannula removal, without symptomatology recurrence in a 3-20 months follow up.
Conclusions:
The thoracoscopic aortopexy is a safe and effective technique to treat primary and severe tracheomalacia in children.
