HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Siegfried Hagl Heinz Jakob Christian Sebening Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hagl, S. Articles by Ulmer, H. Search for Related Content PubMed PubMed Citation Articles by Hagl, S. Articles by Ulmer, H. Related Collections Related Article

Ann Thorac Surg 1997;64:1412-1420
© 1997 The Society of Thoracic Surgeons

---

Original Articles: General Thoracic

External Stabilization of Long-Segment Tracheobronchomalacia Guided by Intraoperative Bronchoscopy

Departments of Cardiac Surgery, Pediatric Cardiology, and Anesthesiology, University Hospital and Clinic for Thoracic Medicine, Heidelberg, Germany

Background. Symptomatic obstruction of long-segment tracheal or bronchial portions either related to congenital instability or secondary to vascular compression are rare malformations, which remain difficult to manage. A method of external tracheal or bronchial stabilization is described.

Methods. From July 1992 to April 1995, 7 children (age range, 4 months to 4 years; mean age, 19 months) and 1 adult (age, 46 years) were operated on for severe respiratory insufficiency. In 4 cases of congenital tracheal instability, 2 children had associated type IIIb esophageal atresia. Both children with esophageal atresia had previous operations (two and three times, respectively): 1 child had aortopexy and division of a patent ductus arteriosus and another child had distal tracheal resection elsewhere, both without relief of malacia. All children were intubated and ventilated since birth for 11 to 15 months. Secondary tracheobronchomalacia due to vascular compression was seen in 4 patients caused by double aortic arch (n = 2) and persisting ligamentum arteriosum after previous ligation of a patent ductus arteriosus (n = 2), with 1 child ventilated thereafter for 5 months. Operation was performed with the aid of extracorporeal circulation in all patients but 1, and consisted of transection of vascular rings and persistent ligamentum Botalli (n = 5), closure of multiple ventricular septal defects (n = 1) and extensive mobilization of the tracheobronchial tree as well as the great arteries. External stabilization of the severely dysplastic distal trachea (n = 6) or left main bronchus (n = 2) was achieved by suspending the malacic segment within an oversized and longitudinally opened ring-reinforced polytetrafluoroethylene prosthesis. Multiple plegeted sutures were placed extramucosally to the dysplastic tracheal wall and the dyskinetic pars membranacea, as well as to the polytetrafluoroethylene prosthesis in a radial orientation. Guided by simultaneous video-assisted bronchoscopy, reexpansion of the collapsed segments was achieved by gentle traction on the sutures while tying.

Results. Stenosis-free tracheobronchial reexpansion was achieved in all patients, as seen on repeated bronchoscopies during hospitalization and thereafter. All patients were extubated within 1 to 12 days after the operation. There was one late death, unrelated to the procedure, in a 31-month-old child 20 months after the operation. All other patients are free of stridor and in excellent clinical condition 21 to 54 months (mean, 38 months) thereafter.

Conclusions. The presented method of bronchoscopically guided external tracheobronchial suspension within a ring-reinforced polytetrafluoroethylene prosthesis immediately relieves severe malacia of the trachea or main bronchi in infants as well as adults without necessitating resection. Midterm preliminary data suggest that growth potential of the affected segment exists within the oversized polytetrafluoroethylene prosthesis.

Related Article

Discussion
Ann. Thorac. Surg. 1997 64: 1421. [Extract] [Full Text]

This article has been cited by other articles:

				J. W. Brown, M. Ruzmetov, P. Vijay, M. D. Rodefeld, and M. W. Turrentine Surgical Treatment of Absent Pulmonary Valve Syndrome Associated With Bronchial Obstruction Ann. Thorac. Surg., December 1, 2006; 82(6): 2221 - 2226. [Abstract] [Full Text] [PDF]

				W. Beierlein and M. J. Elliott Variations in the technique of slide tracheoplasty to repair complex forms of long-segment congenital tracheal stenoses. Ann. Thorac. Surg., October 1, 2006; 82(4): 1540 - 1542. [Abstract] [Full Text] [PDF]

				S. Iwasa, T. Shin'oka, T. Sakamoto, Y. Nagase, H. Hasegawa, and H. Kurosawa Successful extracardiac total cavo pulmonary connection (TCPC) after external tracheobronchial stenting for tracheobronchomalacia Interactive CardioVascular and Thoracic Surgery, October 1, 2006; 5(5): 599 - 601. [Abstract] [Full Text] [PDF]

				L. Nolke, A. Azakie, P. V. Anagnostopoulos, N. Alphonso, and T. R. Karl The Lecompte Maneuver for Relief of Airway Compression in Absent Pulmonary Valve Syndrome. Ann. Thorac. Surg., May 1, 2006; 81(5): 1802 - 1807. [Abstract] [Full Text] [PDF]

				T. Loukanov, C. Sebening, W. Springer, H. Ulmer, and S. Hagl Simultaneous management of congenital tracheal stenosis and cardiac anomalies in infants J. Thorac. Cardiovasc. Surg., December 1, 2005; 130(6): 1537 - 1541. [Abstract] [Full Text] [PDF]

				T. Sakamoto, Y. Nagase, H. Hasegawa, T. Shin'oka, H. Tomimatsu, and H. Kurosawa One-stage intracardiac repair in combination with external stenting of the trachea and right bronchus for tetralogy of Fallot with an absent pulmonary valve and tracheobronchomalacia J. Thorac. Cardiovasc. Surg., December 1, 2005; 130(6): 1717 - 1718. [Full Text] [PDF]

				J. B. Pillai, J. Smith, A. Hasan, and D. Spencer Review of pediatric airway malacia and its management, with emphasis on stenting Eur. J. Cardiothorac. Surg., January 1, 2005; 27(1): 35 - 44. [Abstract] [Full Text] [PDF]

				T. Loukanov, C. Sebening, W. Springer, and S. Hagl A Case of Pulmonary Artery Sling Associated With Long-Segment Funnel Trachea and Bronchus Suis Ann. Thorac. Surg., November 1, 2004; 78(5): 1839 - 1842. [Abstract] [Full Text] [PDF]

				P. Bugmann, P. C. Rimensberger, A. Kalangos, C. Barazzone, M. Beghetti, and F. J. W. Lang Extratracheal Biodegradable Splint to Treat Life-Threatening Tracheomalacia Ann. Thorac. Surg., October 1, 2004; 78(4): 1446 - 1448. [Abstract] [Full Text] [PDF]

				U. Abdel-Rahman, P. Ahrens, H. G. Fieguth, R. Kitz, K. Heller, and A. Moritz Surgical treatment of tracheomalacia by bronchoscopic monitored aortopexy in infants and children Ann. Thorac. Surg., August 1, 2002; 74(2): 315 - 319. [Abstract] [Full Text] [PDF]

				P. A. Catarino, S. Saito, and S. Westaby Dental bar tracheopexy in a neonate Ann. Thorac. Surg., September 1, 2001; 72(3): 943 - 944. [Abstract] [Full Text] [PDF]