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Ann Thorac Surg 2002;74:315-319
© 2002 The Society of Thoracic Surgeons

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Original article: general thoracic

Surgical treatment of tracheomalacia by bronchoscopic monitored aortopexy in infants and children

^a Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe-University, Frankfurt/Main, Germany
^b Department of Pediatric Pneumology, Johann Wolfgang Goethe-University, Frankfurt/Main, Germany
^c Department of Pediatric Surgery, Johann Wolfgang Goethe-University, Frankfurt/Main, Germany

Accepted for publication March 26, 2002.

* Address reprint requests to Dr Abdel-Rahman, Department of Thoracic and Cardiovascular Surgery, J. W. Goethe University, Theodor-Stern-Kai 7, D 60590 Frankfurt/Main, Germany
e-mail: abdel-rahman{at}gmx.de

Background. Aortopexy has become an established surgical procedure for the treatment of severe tracheomalacia (TM) in infancy. However, postoperative outcome may be improved by intraoperative bronchoscopic control of the aortopexy.

Methods. Between 1992 and 2000, 16 infants and children (2 female, 14 male) with TM were treated by pexis of the aorta via a right (15 patients) or left (1 patient) anterior thoracotomy. Patients age ranged from 4 to 122 months (mean, 26 mon). Three infants had previous surgery for esophagus atresia and tracheoesophageal fistula. Another four patients were operated for gastroesophageal reflux. In all cases, the aortopexy was monitored intraoperatively by bronchoscopy. Respiratory function was verified for each patient by comparing pre- and postoperative tidal expiratory flow values (TEF 25% in ml/sec).

Results. Mean follow-up was 36 months (range, 2 to 60 mo). There was no intraoperative or postoperative mortality. 13 patients showed permanent relief of symptoms. Postoperative median TEF 25% increased significantly compared with preoperative values (81 ml/sec vs. 56 ml/sec; p = 0.016). In one patient repeat aortopexy was necessary.

Conclusions. Aortopexy through a right anterior thoracotomy is an efficient and feasible method in the surgical treatment of TM in infancy and, therefore, can improve postoperative respiratory function. Intraoperative bronchoscopy is advantageous.

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