title: Surgical treatment of tracheomalacia by bronchoscopic monitored aortopexy in infants and children.
abstract: 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.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe-University, Frankfurt/Main, Germany. abdel-rahman@gmx.de
authors.forename: Ulf
authors.initials: U
authors.lastname: Abdel-Rahman
authors.forename: Peter
authors.initials: P
authors.lastname: Ahrens
authors.forename: Hans Gerd
authors.initials: HG
authors.lastname: Fieguth
authors.forename: Richard
authors.initials: R
authors.lastname: Kitz
authors.forename: Klaüs
authors.initials: K
authors.lastname: Heller
authors.forename: Anton
authors.initials: A
authors.lastname: Moritz
mesh_terms: D001011:Aorta / Q000601:surgery*; D001999:Bronchoscopy; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D014133:Tracheal Diseases / Q000601:surgery*