Role of aortopexy in the management of primary tracheomalacia and tracheobronchomalacia

Article Abstract:

Tracheomalacia and tracheobronchomalacia are conditions characterized by abnormally soft cartilage of the trachea (windpipe), and in tracheobronchomalacia, of the bronchi (airways in the lungs) as well. The consequence of this abnormal softening can be collapse of the airways. An innovative surgical method is being used to prevent the cartilage from collapsing and obstructing the airways. Previously, long-term mechanical ventilation (use of a machine to breathe) or tracheostomy (cutting a hole in the neck to allow breathing) were the treatments used. The new technique, aortopexy, attempts to prevent the collapse of the trachea by effectively pulling the trachea open as a nearby artery (the ascending aorta) is surgically attached to the sternum (breast-bone). The medical records of 12 patients with tracheomalacia and five with tracheobronchomalacia who had aortopexy between 1986 and 1988 were reviewed to determine the effectiveness of the surgical procedure. There were 13 boys and four girls, and their ages ranged from one month to seven years, with an average of five months. Six children (35 percent) improved with aortopexy and no further treatment, and five more children (29 percent) were improved with both aortopexy and anti-reflux treatment (for gastroesophageal reflux, the back-flow of acid into the esophagus). Gastroesophageal reflux was present in six of the 10 cases in which aortopexy failed. The authors discuss the association between gastroesophageal reflux and tracheomalacia and suggest that both conditions need to be aggressively treated, but the reflux may have to be resolved before beneficial results of aortopexy are achieved. Tracheostomy should only be used in cases where the treatment of reflux and aortopexy have been unsuccessful. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Surgery, Tracheotomy, Trachea, Pediatric respiratory diseases, Bronchi

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Congenital diaphragmatic defects that present late

Article Abstract:

Two common congenital disorders of the diaphragm, hernia and eventration, are frequently misdiagnosed and thus inappropriately treated. Hernia involves protrusion of the abdominal viscera up through the diaphragm; eventration is an abnormally high leaf of the diaphragm, which can be caused by paralysis, lack of development of the diaphragm, or degeneration of muscle fibers. A study of 22 children with diaphragmatic defects diagnosed after the first month of life revealed that the most common symptom of these disorders was a failure to thrive, manifested most frequently by inadequate weight gain. Other symptoms included abdominal pain and vomiting, chronic respiratory symptoms, and inability to breathe without mechanical ventilation. Some cases were without symptoms. Although once diagnosed the conditions could be surgically corrected, there is concern about delay in diagnosis. One source of delay may be a normal chest X-ray. In the case of a hernia, the herniated tissues may have receded back into the abdomen at the time the X-ray was taken, leading to a mistaken belief that the diaphragm was normal. When the patient cannot be weaned off the ventilator, pleural effusion is often suspected. Various tests may be done that will reveal abnormalities in the diaphragm, including radiological scanning of the liver and spleen, umbilical venography, CAT scan, contrast peritoneography, barium meal examination and ultrasound scans. Where the diaphragm is not readily visible on X-ray, a diaphragmatic defect should be suspected. Once diagnosed, the defect should be treated surgically as soon as possible. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Hernia, Diaphragm, Diaphragmatic hernia, Diaphragm (Anatomy)

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Aneurysm of the ductus arteriosus

Article Abstract:

An aneurysm, or blood-filled expansion of the ductus arteriosus (a 'communication' between the fetal aorta and pulmonary artery that is normally closed by the time of birth) is uncommon and not readily recognizable. A case report describing the disease in two infants illustrates the benefit of echocardiography in making this diagnosis. In the first case, a three-week-old boy was previously treated for an upper respiratory infection, but was admitted to the intensive care unit after increasing respiratory distress and tachycardia (rapid heart beat). An echocardiogram revealed normal heart formation plus a thick-walled mass, which turned out to be a ductal aneurysm. The aneurysm ruptured during surgery and attempts to control the bleeding were unsuccessful. In the second case, a baby boy delivered by cesarean section was not breathing and had to be put on a respirator. An echocardiogram revealed normal heart formation and confirmed a ductal aneurysm. Daily echocardiograms verified that the size of the aneurysm was steadily decreasing. After one week, the aneurysm had resolved. The authors recommend that echocardiographic monitoring of an aneurysm is preferable, but cardiopulmonary bypass surgery might be necessary when a ruptured aneurysm is suspected. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Diagnosis, Patent ductus arteriosus, Aneurysms, Aneurysm, Ductus arteriosus

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