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Ann Thorac Surg 2006;82:768-769
© 2006 The Society of Thoracic Surgeons

Correspondence

Reply

Cameron D. Wright, MD, Hermes C. Grillo, MD

Massachusetts General Hospital, Blake 1580, Massachusetts General, 55 Fruit St, Boston, MA 02114

(Email: wright.cameron{at}mgh.harvard.edu).

To the Editor:

We agree with Murgu and Colt [1] that careful definitions are in order. Our patients all had tracheobronchomalacia (TBM) as they describe it rather than excessive dynamic airway collapse (EDAC) [2]. We have not operated on patients with EDAC with the technique of posterior membranous splinting. All of our patients have had "soft" tracheal cartilages and an archer's bow deformity of their trachea. However, an important component of obstruction in these patients was marked widening of the membranous tracheal wall and its anterior displacement on expiration, especially when forceful or with cough. We have seen a few patients with EDAC referred for evaluation of "tracheomalacia" but have not offered them an operation. All of these patients have quite normal looking tracheal cartilages with the normal "D" shape. It is possible they may be helped with fixation of the posterior membranous wall, but that remains to be seen. We have viewed patients with EDAC as having a hyperirritable airway and have just recommended medical management of their very common reactive airways disease.


   References
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 References
 

  1. Murgu SD, Colt HG. Expiratory collapse of the central airways(letter) Ann Thorac Surg 2006;82:768.[Free Full Text]
  2. Wright CD, Grillo HC, Hammoud ZT, et al. Tracheoplasty for expiratory collapse of central airways Ann Thorac Surg 2005;80:259-267.[Abstract/Free Full Text]

Related Article

Expiratory Collapse of the Central Airways
Septimiu D. Murgu and Henri G. Colt
Ann. Thorac. Surg. 2006 82: 768. [Extract] [Full Text] [PDF]




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