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286 Tracheomalacia
Table 43.5: Evidence-based research.
Title Aortopexy for tracheomalacia in oesophageal anomalies
Authors Corbally MT, Spitz L, Kiely E, Brereton RJ, Drake DP
Institution The Hospital for Sick Children, Great Ormond Street,
London, UK
Reference Eur J Pediatr Surg 1993; 5:264–266
Problem The problem is significant symptomatic tracheomalacia in
association with repaired congenital oesophageal anomalies.
Indications for surgery included recurrent apnoea/cyanosis
(31), “near fatal episodes” (16), recurrent respiratory distress
and infections (20), and worsening stridor (15).
Intervention Aortopexy
Comparison/
control Case review (level 4). A review of 48 patients over a ten-
(quality of year period who underwent an aortopexy for tracheomalacia
following repair of an oesophageal anomaly.
evidence)
Outcome/ Gastro-oesophageal reflux was also noted in 30 cases.
effect Aortopexy cured near fatal episodes in all patients and
resulted in improvement of airway obstruction in 95%. Failure
in two patients was due to unrecognised bronchomalacia.
Historical
significance/ Aortopexy was recommended as the primary procedure of
choice for significant tracheomalacia.
comments

Key Summary Points

1. An association exists between oesophageal atresia and/or 4. An aortopexy gives excellent results for localised
tracheo-oesophageal fistula (OA/TOF) and tracheomalacia. tracheomalacia in association with OA and TOF.
2. Expiratory stridor should be investigated by bronchoscopy 5. Severe gastro-oesophageal reflux may be associated with
in a self-ventilating patient. tracheomalacia and may require a fundoplication.
3. Anterior-posterior collapse of the tracheal lumen indicates 6. Vascular anomalies associated with tracheomalacia require
severe tracheomalacia, and urgent intervention should be specialised investigations and management in a paediatric
considered. cardiothoracic unit.

References

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for tracheomalacia in oesophageal anomalies. Eur J Pediatr Surg
1993; 3:264–266.