The role of posterior aortopexy in the treatment of left mainstem bronchus compression

• Published in: Interactive cardiovascular and thoracic surgery Vol. 23; no. 5; pp. 699 - 704
• Main Authors: Arcieri, Luigi, Serio, Paola, Nenna, Raffaella, Di Maurizio, Marco, Baggi, Roberto, Assanta, Nadia, Moschetti, Riccardo, Noccioli, Bruno, Mirabile, Lorenzo, Murzi, Bruno
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01-11-2016
• Subjects: Adolescent; Aorta - surgery; Bronchial Diseases - diagnosis; Bronchial Diseases - etiology; Bronchial Diseases - surgery; Bronchoscopy; Child; Child, Preschool; Constriction, Pathologic; Decompression, Surgical; Female; Humans; Infant; Male; Respiration, Artificial; Retrospective Studies; Thoracotomy; Tomography, X-Ray Computed; Bronchial disease; Vascular compression; Bronchial endoscopy; Coronary heart disease; Pulmonary artery
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivw209

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.