Tracheomalacia before and after aortosternopexy: dynamic and quantitative assessment by electron-beam computed...

To correlate the dynamics of tracheal collapse with clinical upper airway obstruction before and after aortosternopexy, seven boys and three girls (mean age, 10 months) underwent dynamic evaluation of the trachea by electron-beam computed tomography (EBCT). The site, extent, and severity of collapse were correlated with symptomatology and details of operative procedure. When > 50 % area collapse was used as the criterion for tracheomalacia, segmental involvement occurred above the aortic arch in all patients, extending to the aortic arch level in only four. Tracheomalacia involved two or fewer 8-mm levels in seven patients and more than two levels in three. Eight patients underwent one aortosternopexy procedure, resulting in clinical improvement in six and correlating well with EBCT findings. Of the remaining two patients who had single aortosternopexy and did not show clinical and radiographic improvement, one required operative repair of a vascular ring and the other continued to have recurrent respiratory tract infections. On the basis of EBCT findings, two patients required additional innominate arteriopexies: one improved, and the other remained symptomatic, requiring tracheostomy. EBCT is a noninvasive modality that allows preoperative diagnosis of tracheomalacia. More importantly, the operative decision and technique are guided by an objective and quantitative assessment of tracheal collapse.