Posterior tracheopexy for severe tracheomalacia

Paediatric tracheomalacia - A review of clinical features and comparison of diagnostic imaging techniques

“…In patients with anterior compression of the trachea, aortopexy can be used to surgically lift the ascending aorta anteriorly and suture it to the posterior surface of the sternum with concurrent removal of the thymus if necessary [15]. In recent years, anterior and posterior tracheopexy have been used to secure the trachea to either the sternum or anterior longitudinal spinal ligament, reducing airway intrusion where a vascular malformation is not the cause [16].…”

Quantitative Assessment of Regional Dynamic Airway Collapse in Neonates via Retrospectively Respiratory‐Gated 1H Ultrashort Echo Time MRI

“…Furthermore, this technique poses no additional risks to patients, and so offers a unique opportunity for serial assessment to guide use of pharmacologic therapy and response to surgical interventions for airway collapse. For example, neonatal patients with severe TM may undergo aortopexy or posterior tracheopexy, with no current noninvasive or nonionizing option for assessing tracheal dynamics before and after surgery. Additionally, Panitch et al demonstrated in a small cohort that cholinergic agents can improve respiratory mechanics in infants with TM, suggesting that stimulation of the trachealis may increase tracheal stability; however, treatment with albuterol caused a decrease in peak expiratory flow.…”

Pediatric tracheomalacia and the perioperative anesthetic management of thoracoscopic posterior tracheopexy

“…Identification and mobilization of esophagus, thoracic duct, and aorta were necessary to approximate the trachea to the prevertebral fascia, while exercising extra caution to protect the left vagus and left recurrent laryngeal nerves . As described in the technique used by Shieh et al, endoluminal bronchoscopy (bronchoscope placed inside the endotracheal tube) was used to assist in suturing the posterior membranous trachea to the anterior spinal ligament (Figure A and B) using nonresorbable 4.0 prolene sutures. Continuous bronchoscopy was performed to ensure that these sutures did not enter the tracheal lumen during placement .…”

“…As described in the technique used by Shieh et al, endoluminal bronchoscopy (bronchoscope placed inside the endotracheal tube) was used to assist in suturing the posterior membranous trachea to the anterior spinal ligament (Figure A and B) using nonresorbable 4.0 prolene sutures. Continuous bronchoscopy was performed to ensure that these sutures did not enter the tracheal lumen during placement . Ventilator settings were titrated to maintain normal values on arterial blood gases.…”

“…The etiology, degree of tracheal narrowing, and severity of clinical symptoms dictates the treatment . A novel approach, thoracoscopic posterior tracheopexy, involves stenting the trachea by attaching the posterior trachea to the anterior longitudinal spinal ligament under guidance of fiberoptic bronchoscopy (FOB) . Although this minimally invasive technique is advantageous for patients with compromised respiratory mechanics, the simultaneous need for operative FOB guidance and lung isolation makes for a challenging anesthetic.…”