Abstract Reference Kimura K. et al.

Unique Identifier

90339324

Authors

Kimura K., Soper R.T., Kao S.C., Sato Y., Smith W.L., and Franken EA.

Title

Aortosternopexy for tracheomalacia following repair of esophageal atresia: evaluation by cine-CT and technical refinement.

Source

Journal of Pediatric Surgery. 25(7):769-72, 1990 Jul.

Abstract

During the period of 1 year (1988 to 1989), five infants, aged 3 weeks to 10 months, presented with recurrent respiratory distress following repair of esophageal atresia with tracheoesphageal fistula (EA/TEF). These patients had associated congenital anomalies, including right aortic arch (1), biliary atresia (1), and a long gap that required esophageal elongation by spiral myotomy (1). The patients were evaluated for tracheomalacia using cinecomputed tomography (cine-CT; C-100 Scanner, Imatron, San Francisco, CA), which provides images of eight levels (8-mm interval) simultaneously with 0.7 second time intervals of cine-CT. Dynamic studies of the trachea by cine-CT showed tracheal collapse that was most significant during expiration in the segment immediately above and at the aortic arch. These patients underwent aortosternopexy. Via a right second intercostal approach, the ascending aorta and aortic arch were lifted anteriorly using two to four sutures of 5-0 Tevdek on pledgets placed between the tunica media and adventitia of the side walls of the aorta and the adjacent sternum. Respiratory distress was significantly improved postoperatively. Preliminary experience with these patients allows us to conclude that (1) cine-CT is a useful technique for diagnosing tracheomalacia; (2) it provides objective indication for its correction by aortosternopexy; and (3) the refined technique in placing sutures on the aorta may reduce the surgical risks of aortosternopexy.

MeSH Heading

Anastomosis, Surgical
Aorta/su [Surgery]
Aorta, Thoracic/su [Surgery]
Esophageal Atresia/co [Complications]
Esophageal Atresia/su [Surgery]
Female
Human
Infant
Infant, Newborn
Male
Postoperative Complications/su [Surgery]
Sternum/su [Surgery]
Tomography, X-Ray Computed
Tracheal Diseases/et [Etiology]
Tracheal Diseases/ra [Radiography]
Tracheal Diseases/su [Surgery]
Tracheoesophageal Fistula/co [Complications]
Tracheoesophageal Fistula/su [Surgery]





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