Hostname: page-component-848d4c4894-cjp7w Total loading time: 0 Render date: 2024-06-22T06:30:08.830Z Has data issue: false hasContentIssue false
  • English
  • Français

Aortopexy for the management of paediatric tracheomalacia – the Alder Hey experience

Published online by Cambridge University Press:  23 January 2020

S P Williams ,
P D Losty ,
R Dhannapuneni ,
A Lotto ,
R Guerrero  and
A J Donne
S P Williams*
Affiliation:
Department of Paediatric ENT, Alder Hey Children's Hospital, Liverpool, UK
P D Losty
Affiliation:
Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool, UK
R Dhannapuneni
Affiliation:
Department of Paediatric Cardiothoracic Surgery, Alder Hey Children's Hospital, Liverpool, UK
A Lotto
Affiliation:
Department of Paediatric Cardiothoracic Surgery, Alder Hey Children's Hospital, Liverpool, UK
R Guerrero
Affiliation:
Department of Paediatric Cardiothoracic Surgery, Alder Hey Children's Hospital, Liverpool, UK
A J Donne
Affiliation:
Department of Paediatric ENT, Alder Hey Children's Hospital, Liverpool, UK
*
Author for correspondence: Mr Stephen P Williams, Department of Paediatric ENT, Liverpool, L14 5AB, UK E-mail: spwilliams@doctors.org.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Whilst aortopexy is an accepted and established procedure, there remains considerable heterogeneity within the literature, with inconsistencies in both the approach taken and the technique employed. Furthermore, limited data exist on both patient selection and long-term outcomes. This study aimed to report the experience of managing severe tracheomalacia by way of aortopexy in a large UK paediatric centre.

Method

A retrospective case note review was conducted. Mean follow up was five years.

Results

Twenty-five patients underwent aortopexy for severe tracheomalacia caused by external vascular compression. Acute life-threatening events precipitated investigation in 72 per cent of cases. Twenty-one patients initially presented to ENT services for investigation, which comprised upper airway endoscopy and imaging with computed tomography angiography. Post-operatively, the majority of patients demonstrated complete resolution of symptoms and were discharged from all associated services. Only four patients required a tracheostomy.

Conclusion

Aortopexy offers an effective method of treating severe tracheomalacia due to vascular compression.

Keywords

TracheomalaciaTracheaBrachiocephalic TrunkVascular Ring
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 134 , Issue 2 , February 2020 , pp. 174 - 177
Copyright
Copyright © JLO (1984) Limited, 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Mr S P Williams takes responsibility for the integrity of the content of the paper

References

Goyal, V, Masters, IB, Chang, AB. Interventions for primary (intrinsic) tracheomalacia in children. Cochrane Database Syst Rev 2012;(10):CD005304Google ScholarPubMed
Gross, RE, Newhauser, EBD. Compression of the trachea by an anomalous innominate artery – an operation for its relief. Am J Dis Child 1948;75:570–410.1001/archpedi.1948.02030020585007CrossRefGoogle ScholarPubMed
Jennings, RW, Hamilton, TE, Smithers, CJ, Ngerncham, M, Feins, N, Foker, JE. Surgical approaches to aortopexy for severe tracheomalacia. J Pediatr Surg 2014;49:66–7210.1016/j.jpedsurg.2013.09.036CrossRefGoogle ScholarPubMed
Torre, M, Carlucci, M, Speggiorin, S, Elliott, MJ. Aortopexy for the management of tracheomalacia in children: review of the literature. Ital J Pediatr 2012;38:6210.1186/1824-7288-38-62CrossRefGoogle Scholar
Weber, TR, Keller, MS, Fiore, A. Aortic suspension (aortopexy) for severe tracheomalacia in infants and children. Am J Surg 2002;184:573–710.1016/S0002-9610(02)01054-1CrossRefGoogle ScholarPubMed
Corbally, MT, Spitz, L, Kiely, E, Brereton, RJ, Drake, DP. Aortopexy for tracheomalacia in oesophageal abnormalities. Eur J Pediatr Surg 1993;3:264–610.1055/s-2008-1063556CrossRefGoogle Scholar
Wittenborg, MH, Gyepes, MT, Crocker, D. Tracheal dynamics in infants with respiratory distress, stridor and collapsing trachea. Radiology 1967;88:653–6210.1148/88.4.653CrossRefGoogle ScholarPubMed
Vinograd, I, Filler, RM, Bahoric, A. Long-term functional results of prosthetic airway splinting in tracheomalacia and bronchomalacia. J Pediatr Surg 1987;22:441–210.1016/S0022-3468(87)80011-8CrossRefGoogle ScholarPubMed
Calkoen, EE, Gabra, HOS, Roebuck, DJ, Kiely, E, Elliott, MJ. Aortopexy as treatment for tracheo-bronchomalacia in children: an 18-year single-centre experience. Paediatr Crit Care Med 2011;12:545–5110.1097/PCC.0b013e3182070f6fCrossRefGoogle Scholar