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Congenital Laryngeal Disease
Published in Raymond W Clarke, Diseases of the Ear, Nose & Throat in Children, 2023
TOF is often associated with other congenital abnormalities including vertebral, anal, cardiac, tracheal, renal and limb (VACTERL). Tracheomalacia is common, and some children will require tracheostomy in addition to surgical repair of the TOF, often for a prolonged period. ‘Aortopexy’ – anchoring the aortic arch which is closely attached to the anterior tracheal wall – to the ventral surface of the sternum may help to hoist the trachea forward and increase the patency of the lumen.
Congenital Disorders of the Larynx, Trachea and Bronchi
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
Mild tracheobronchomalacia (less than 75% collapse) requires no intervention, and the stridor can be expected to resolve spontaneously by around the age of 2 years. However, parents will require careful explanation and reassurance, as well as being taught cardiopulmonary resuscitation if their child is prone to ‘dying spells’. Severe tracheobronchomalacia (more than 75% collapse) may require treatment, especially if associated with failure to thrive. If it is secondary to a vascular anomaly, this should be corrected. The severe localized tracheomalacia often associated with a TOF usually responds well to an aortopexy, whereby the aorta is sutured to the back of the sternum. If this fails, an extended tracheostomy tube will effectively support a midtracheal malacic segment, but this is not a satisfactory solution for lower-end tracheal or for bronchial collapse. For the infant in intensive care with severe primary tracheobronchomalacia who cannot be weaned off CPAP, it may be necessary to resort to a tracheostomy in order to apply long-term CPAP. Alternative surgical solutions for this most severe end of the disease spectrum have been sought by cardiothoracic surgeons: these include internal or external stenting of the trachea, segmental resection and cartilage grafting, but all present formidable difficulties and complications with very variable outcome, and the risks may exceed those of the condition itself.
Congenital anomalies of the oesophagus
Published in Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven, Succeeding in Paediatric Surgery Examinations, 2017
In severe cases the child may have acute, life-threatening apnoeic spells, and these are the patients who may benefit from aortopexy. The weak trachea is compressed between the dilated oesophagus and aorta, and the pressure can be relieved by doing an aortopexy that fixes the aorta to the sternum
Flexible airway endoscopy in esophageal atresia patients undergoing colon interposition
Published in Egyptian Journal of Anaesthesia, 2021
Aliaa Rabie, Mohamed El Debeiky, Tamer Ghoneim, Ahmed Khairi, Ahmed Ezzat Mrzouk Saad El-Rouby
Aortopexy is preferred surgical treatment of severe cases of TM in many centers, wherein lifting anteriorly the aorta and suturing it to the posterior surface of the sternum. As the anterior tracheal wall is attached through pre-tracheal fascia to the posterior aortic wall, the tracheal lumen is opened by aortopexy [9]. Interestingly, posterior tracheopexy to the anterior longitudinal spinal ligament applicable in a case of severe tracheomalacia is associated with esophageal atresia (EA), and could be primary treatment at the time of initial EA repair or secondary treatment at the time of esophageal reconstruction surgery [10].