Management of tracheomalacia in an infant with Tetralogy of Fallot

Abstract

Most infants with tracheomalacia do not need specific therapy as it usually resolves spontaneously by the age of 1–2 years. Severe forms of tracheomalacia characterized by recurrent respiratory infections require active treatment which includes chest physiotherapy, long term intubation or tracheostomy. Aortopexy seems to be the treatment of choice for secondary and even primary forms of severe tracheomalacia. Itentails tracking and suturing the anterior wall of the aorta to the posterior surface of the sternum. Consequently, the anterior wall of the trachea is also pulled forward preventing its collapse. A 3-month-old girl baby who was on ventilatory support for 2 months due to severe tracheomalacia associated with a cyanotic congenital heart disease underwent intracardiac repair and aortopexy along with Lecompte's procedure as all the conservative measures to wean off the ventilator failed. The baby was extubated on the third post-operative day and the post-operative period was uneventful.

Epidemiology and Management of Pediatric Tracheomalacia

“…Congenital tracheomalacia is uncommon, and no definitive incidence figures exist. The incidence of tracheomalacia was predicted to be at least 1 in 2100 in all age groups [15]. (incidence of approximately 1 in 1500 to 2500 children in a study in The Netherlands) [20] tracheomalacia is more frequent in babies and children with Cystic Fibrosis (CF) than in the general population, and it's linked to airway obstruction and Pseudomonas infection, the incident of CF itself is about 1 in 3,000 [21].…”