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Anna Gruszka, Joerg S Sachweh, Heike Schnoering, Klaus Tenbrock, Eberhard G Muehler, Michael Laschat, Jaime F Vazquez-Jimenez
OBJECTIVES: Aortopexy is widely used; however, many surgeons still regard it with suspicion. To date, there are only a few large series and minimal long-term data. Against this background, our goal was to report our experience, particularly with regard to the recent expansion of indications and modification of diagnostic routine and surgical strategy. METHODS: Between 1994 and 2012, 53 patients (mean age: 1.1 years; 5 weeks-10.2 years) were operated on. Tracheomalacia after the operation for oesophageal atresia was the main indication for aortopexy (74%), followed by tracheal compression by the innominate artery (17%) and other selected indications (9%)...
June 9, 2017: Interactive Cardiovascular and Thoracic Surgery
Hester F Shieh, C Jason Smithers, Thomas E Hamilton, David Zurakowski, Lawrence M Rhein, Michael A Manfredi, Christopher W Baird, Russell W Jennings
PURPOSE: In severe tracheomalacia, aortopexy addresses anterior vascular compression, but does not directly address posterior membranous tracheal intrusion. We review patient outcomes of posterior tracheopexy for tracheomalacia with posterior intrusion to determine if there were resolution of clinical symptoms and bronchoscopic evidence of improvement in airway collapse. METHODS: All patients who underwent posterior tracheopexy from October 2012 to March 2016 were retrospectively reviewed...
June 2017: Journal of Pediatric Surgery
Akiko Yokoi, Yoshihiro Oshima, Eiji Nishijima
PURPOSE: Congenital tracheal stenosis (CTS) and a single right lung treated with slide tracheoplasty (ST) has relatively high rates of mortality and morbidity. We report a single institution's experience with adjunctive procedures at the time of ST to reduce postoperative tracheal obstruction in patients with a single right lung and CTS. METHODS: With IRB approval, 8 patients with a single right lung and CTS who underwent ST in our institution between 2008 and 2016 were reviewed...
May 2017: Journal of Pediatric Surgery
Hiroomi Okuyama, Yuko Tazuke, Takehisa Uenoa, Hiroaki Yamanaka, Yuichi Takama, Ryuta Saka, Keigo Nara, Noriaki Usui
PURPOSE: To investigate the long-term morbidity of surgically treated esophageal atresia (EA) in adolescents and young adults and establish whether these long-term morbidities are affected by the type of EA. PATIENTS AND METHODS: We reviewed the medical records, including backgrounds and associated conditions, of 69 long-term survivors of EA, aged >15 years. The long-term morbidities included neurodevelopmental abnormality, nutritional impairment (short height <-2SD, low BMI <18...
December 27, 2016: Surgery Today
William S Ragalie, Michael E Mitchell
Tracheobronchomalacia (TBM) is frequently present in infants and children with congenital heart disease (CHD). Infants with CHD and TBM appear to do worse than those without TBM. The principle of operative intervention for TBM is to improve function of the airway and clinical status. When indicated, conventional surgical options include tracheostomy, aortopexy, tracheoplasty, and anterior tracheal suspension. There is no consensus on the optimal treatment of severe tracheobonchomalacia, which can be associated with a mortality rate as high as 80%...
December 0: Seminars in Thoracic and Cardiovascular Surgery
Luigi Arcieri, Paola Serio, Raffaella Nenna, Marco Di Maurizio, Roberto Baggi, Nadia Assanta, Riccardo Moschetti, Bruno Noccioli, Lorenzo Mirabile, Bruno Murzi
OBJECTIVES: We reviewed the role of posterior aortopexy for left mainstem bronchus compression in infants and children. METHODS: Eighteen children with respiratory symptoms were enrolled between 2005 and 2015 for surgical decompression of the left mainstem bronchus. The children were managed from diagnosis to follow-up by a dedicated tracheal team. Primary outcomes were the complete relief of symptoms or improvement with respect to preoperative clinical status. RESULTS: The median age was 4 years (0...
November 2016: Interactive Cardiovascular and Thoracic Surgery
Christopher W Baird, Sanjay Prabhu, Terry L Buchmiller, Charles Smithers, Russell Jennings
Complex tracheobronchial obstruction and malacia can be associated with conotruncal and aortic arch anomalies. A circumflex aortic arch composed of a left aortic arch and right descending aorta is an extremely rare anomaly that can severely affect the distal trachea and mainstem bronchi, resulting in severe respiratory symptoms. We report the case of a patient with circumflex aortic arch and severe left mainstem bronchial obstruction and malacia in which the external aortic compression and residual bronchomalacia were addressed with direct bronchial and tracheal intervention...
July 2016: Annals of Thoracic Surgery
E Dean McKenzie, Mark E Roeser, Jess L Thompson, Luis E De León, Iki Adachi, Jeffrey S Heinle, Carlos M Mery, Charles D Fraser
BACKGROUND: A descending thoracic aorta that traverses the midline is an uncommon cause of airway compression affecting the distal trachea and proximal main bronchi. Posterior aortopexy has had inconsistent results. METHODS: A retrospective review determined that, since 2004, 5 children have undergone descending aortic translocation at Texas Children's Hospital. The average age at the time of surgical treatment was 4.2 years, and all patients presented with recurring respiratory illness requiring hospitalization...
September 2016: Annals of Thoracic Surgery
Oliviero Sacco, Francesco Santoro, Elena Ribera, Gian Michele Magnano, Giovanni A Rossi
An entity that has received little attention as cause or recurrent respiratory disorder is the narrowing of the left main stem bronchus. When not associated with congenital heart disorders, this condition has been ascribed to primary localized malacia of the bronchial cartilages or to the anterior displacement of the descending aorta in front to the adjacent vertebral bodies. Four girls were evaluated for recurrent/chronic respiratory symptoms. A pulsatile extrinsic compression on the posterior bronchial wall of the left main stem bronchus was detected, pressed between the descending aorta, posteriorly, and the left pulmonary artery, anteriorly...
December 2016: Pediatric Pulmonology
David Horne, Michelle Noga, Vijay Anand, Ivan M Rebeyka
Tracheal obstruction secondary to vascular and soft tissue compression, after Nikaidoh procedure, can effectively be managed with aortopexy from a suprasternal incision.
January 2017: World Journal for Pediatric & Congenital Heart Surgery
Lorraine A de Trey, Julia Dudley, Hasnaa Ismail-Koch, Andrew Durward, Hannah Bellsham-Revell, Sean Blaney, Ian Hore, Conal B Austin, Gavin A Morrison
INTRODUCTION: Paediatric tracheobronchomalacia is a rare but potentially serious condition. Severe tracheobronchomalacia requires intervention or operation. This is an evaluation of a ten-year experience at an institution. METHODS: In this retrospective study all patients were included that required an intervention for severe tracheobronchomalacia from 2003 to 2012. Symptoms, aetiology, comorbidities, localisation of the malacia, age at diagnosis, therapeutic measures and associated complications were evaluated...
April 2016: International Journal of Pediatric Otorhinolaryngology
JongEun Oh, Jung-Won Kim, Won-Jung Shin, Mijeung Gwak, Pyung Hwan Park
Compression of the airway is relatively common in pediatric patients, although it is often an unrecognized complication of congenital cardiac and aortic arch anomalies. Aortopexy has been established as a surgical treatment for tracheobronchial obstruction associated with vascular anomaly, aortic arch anomaly, esophageal atresia, and tracheoesophageal fistula. The tissue-to-tissue arch repair technique could result in severe airway complication such as compression of the left main bronchus which was not a problem before the correction...
February 2016: Korean Journal of Anesthesiology
Matthew J Hartley, Nicholas P M Smith, Bruce Jaffray
AIM OF STUDY: We examined variables associated with survival for oesophageal atresia between 1996 and 2014. METHODS: Possible explanatory variables: birth weight, gestation, cardiac anomalies (any or major), renal anomalies (any or severe), primary anastomosis, leak, secondary oesophageal surgery, tracheomalacia, aortopexy, tracheostomy, gastrostomy, fundoplication, karyotype, neurological status. Variables were assessed with logistic regression and a new model assessed with Kaplan-Meier graphs...
July 2016: Journal of Pediatric Surgery
Ryuma Iwaki, Tomonori Higuma, Fukiko Ichida, Naoki Yoshimura
Persistent respiratory symptoms often occur after surgical repair of double aortic arch (DAA). Most often, symptoms are relatively mild and tend to be self-limited and improve with growth. Multidetector computed tomography (MDCT) imaging can be used to obtain needed anatomic information regarding the potential for extrinsic airway compression and is minimally invasive, safe, and readily available after surgery. We herein report the cases of two patients with persistent airway symptoms after surgical therapy for a double aortic arch...
July 2015: World Journal for Pediatric & Congenital Heart Surgery
Michele Ghezzi, Michela Silvestri, Oliviero Sacco, Serena Panigada, Donata Girosi, Gian Michele Magnano, Giovanni A Rossi
BACKGROUND: In children with aberrant innominate artery (AIA) one of the most prevalent respiratory symptom is dry cough. How frequently this mediastinal vessels anomaly, that can induce tracheal compression (TC) of different degree, may be detected in children with chronic dry cough is not known. METHODS: In a 3-year retrospective study, the occurrence of mediastinal vessels abnormalities and the presence and degree of TC was evaluated in children with recurrent/chronic dry cough...
March 2016: Pediatric Pulmonology
Hee Suk Jung, Jee Won Suh, Tae Hoon Kim, Chang Young Lee, Kyung Young Chung
Postpneumonectomy syndrome (PPS) is a rare late complication of pneumonectomy. It occurs more often in children than in adults, and is characterized by respiratory failure resulting from bronchial compression caused by severe mediastinal shift. Various methods have been used to treat PPS, including aortopexy and the insertion of plastic balls, silastic implants, and saline-filled breast prostheses. We describe two cases of PPS corrected with tissue expanders after right pneumonectomy in patients with esophageal atresia...
June 2015: Korean Journal of Thoracic and Cardiovascular Surgery
Santoshi Kurada, Ranjith B Karthekeyan, Mahesh Vakamudi, Periyasamy Thangavelu
Most infants with tracheomalacia do not need specific therapy as it usually resolves spontaneously by the age of 1-2 years. Severe forms of tracheomalacia characterized by recurrent respiratory infections require active treatment which includes chest physiotherapy, long term intubation or tracheostomy. Aortopexy seems to be the treatment of choice for secondary and even primary forms of severe tracheomalacia. Itentails tracking and suturing the anterior wall of the aorta to the posterior surface of the sternum...
April 2015: Indian Journal of Anaesthesia
Sigrid Bairdain, Charles Jason Smithers, Thomas E Hamilton, David Zurakowski, Lawrence Rhein, John E Foker, Christopher Baird, Russell W Jennings
PURPOSE: Tracheobronchomalacia (TBM) is associated with esophageal atresia, tracheoesophageal fistulas, and congenital heart disease. TBM results in chronic cough, poor mucous clearance, and recurrent pneumonias. Apparent life-threatening events or recurrent pneumonias may require surgery. TBM is commonly treated with an aortopexy, which indirectly elevates trachea's anterior wall. However, malformed tracheal cartilage and posterior tracheal membrane intrusion may limit its effectiveness...
June 2015: Journal of Pediatric Surgery
Monawat Ngerncham, Edward Y Lee, David Zurakowski, Donald A Tracy, Russell Jennings
PURPOSE: Diagnostic laryngoscopy and bronchoscopy (DLB) has been the traditional preoperative diagnostic modality for evaluating presence and severity of tracheobronchomalacia (TBM), and requires anesthesia. Alternatively, multidetector computed tomography (MDCT) is potentially a noninvasive modality that provides high-resolution, 3-dimensional (3D) imaging of the thorax providing preoperative guidance for pediatric surgeons. This study compares MDCT with intraoperative DLB in the assessment of TBM in symptomatic pediatric patients with esophageal atresia (EA)...
March 2015: Journal of Pediatric Surgery
Eiji Nishijima
Surgical strategies and treatment for pediatric airway and lung diseases have advanced significantly, especially in the fields of subglottic stenosis, congenital tracheal stenosis, congenital cystic lung lesions, and endoscopic surgery, during the past 50 years. Pediatricians, pathologists, and pediatric surgeons have engaged in continuous discussions at scientific meetings to establish standard terminology and operative indications and to refine surgical techniques such as laryngoplasty, sliding tracheoplasty, lobectomy under thoracotomy and thoracoscopy...
November 2014: Nihon Geka Gakkai Zasshi
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