title: The role of posterior aortopexy in the treatment of left mainstem bronchus compression.
abstract: We reviewed the role of posterior aortopexy for left mainstem bronchus compression in infants and children.
  
  
  
  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.
  
  
  
  The median age was 4 years (0.3-15.4) and the median weight was 13.2 kg (3, 1-40). Symptoms or indications for bronchoscopy included difficult weaning from mechanical ventilation (n = 3, 17%), difficult weaning from tracheotomy (n = 4, 22%), recurrent pneumonia (n = 4, 22%), wheezing (n = 3, 17%), atelectasis (n = 1, 5.5%), bitonal cough (n = 1, 5.5%) and stridor (n = 2, 11%). Associated malformations were present in 88.7%. The diagnosis was made by bronchoscopy and computed tomography. Indication for surgery was the presence of pulsations and reduction in the diameter of the left mainstem bronchus compression of more than 70%. Surgery was performed by left posterolateral thoracotomy. Aortopexy was done under bronchoscopic control. No early or late deaths were observed, nor were reoperations necessary. Residual malacia was observed in 8 children (44%). Median follow-up was 4.1 years (0.1-7.1). At last follow-up, 17/18 (94.4%) children showed adequate airway patency.
  
  
  
  The intrathoracic location of the left mainstem bronchus predisposes it to compression. Vascular anomalies represent the most frequent causes. Aortopexy has been advocated as a safe and useful method to relieve the compression, and our results confirmed these findings. Management of these patients is challenging and requires a multidisciplinary team.
authors.affiliation: Pediatric Cardiac Surgery Unit, Heart Hospital, G. Monasterio Foundation, Massa, Italy luigi.arcieri@gmail.com.
authors.forename: Luigi
authors.initials: L
authors.lastname: Arcieri
authors.affiliation: Pediatric Intensive Care Unit and Bronchoscopy Service, Meyer Hospital, Florence, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Serio
authors.affiliation: Department of Pediatrics and Infantile Neuropsychiatry, Sapienza University, Rome, Italy.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Nenna
authors.affiliation: Pediatric Radiology Unit, Meyer Hospital, Florence, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Di Maurizio
authors.affiliation: Pediatric Intensive Care Unit and Bronchoscopy Service, Meyer Hospital, Florence, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Baggi
authors.affiliation: Pediatric Cardiology Unit, Heart Hospital, G. Monasterio Foundation, Massa, Italy.
authors.forename: Nadia
authors.initials: N
authors.lastname: Assanta
authors.affiliation: Pediatric Intensive Care Unit, Heart Hospital, G. Monasterio Foundation, Massa, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Moschetti
authors.affiliation: Pediatric Surgery Unit, Meyer Hospital, Florence, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Noccioli
authors.affiliation: Pediatric Intensive Care Unit and Bronchoscopy Service, Meyer Hospital, Florence, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Mirabile
authors.affiliation: Pediatric Cardiac Surgery Unit, Heart Hospital, G. Monasterio Foundation, Massa, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Murzi
mesh_terms: D000293:Adolescent; D001011:Aorta / Q000601:surgery*; D001982:Bronchial Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D001999:Bronchoscopy; D002648:Child; D002675:Child, Preschool; D003251:Constriction, Pathologic; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012121:Respiration, Artificial; D012189:Retrospective Studies; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed
keywords: Bronchial disease; Bronchial endoscopy; Coronary heart disease; Pulmonary artery; Vascular compression