Luigi Arcieri1, Paola Serio2, Raffaella Nenna3, Marco Di Maurizio4, Roberto Baggi2, Nadia Assanta5, Riccardo Moschetti6, Bruno Noccioli7, Lorenzo Mirabile2, Bruno Murzi8. 1. Pediatric Cardiac Surgery Unit, Heart Hospital, G. Monasterio Foundation, Massa, Italy luigi.arcieri@gmail.com. 2. Pediatric Intensive Care Unit and Bronchoscopy Service, Meyer Hospital, Florence, Italy. 3. Department of Pediatrics and Infantile Neuropsychiatry, Sapienza University, Rome, Italy. 4. Pediatric Radiology Unit, Meyer Hospital, Florence, Italy. 5. Pediatric Cardiology Unit, Heart Hospital, G. Monasterio Foundation, Massa, Italy. 6. Pediatric Intensive Care Unit, Heart Hospital, G. Monasterio Foundation, Massa, Italy. 7. Pediatric Surgery Unit, Meyer Hospital, Florence, Italy. 8. Pediatric Cardiac Surgery Unit, Heart Hospital, G. Monasterio Foundation, Massa, Italy.
Abstract
OBJECTIVES: We reviewed the role of posterior aortopexy for left mainstem bronchus compression in infants and children. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
OBJECTIVES: We reviewed the role of posterior aortopexy for left mainstem bronchus compression in infants and children. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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: Andrea S Les; Richard G Ohye; Amy G Filbrun; Maryam Ghadimi Mahani; Colleen L Flanagan; Rodney C Daniels; Kelley M Kidwell; David A Zopf; Scott J Hollister; Glenn E Green Journal: Laryngoscope Date: 2019-02-22 Impact factor: 3.325