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Surgery for Membranous Tracheomalacia: Tracheobronchoplasty

Thursday, March 25, 2021

Fos AM, Madueño FC, Cosano J, et al. Surgery for Membranous Tracheomalacia: Tracheobronchoplasty. March 2021. doi:10.25373/ctsnet.14242121

The authors present a 59-year-old woman with a history of asthma, episodes of bronchospasm, and multiple ICU readmissions requiring orotracheal intubation. After a trial period with a tracheobronchial Y-shaped silicone stent (DumonTM stent), a tracheobronchoplasty was indicated as a definitive surgical treatment.

The objective of surgery was to stabilize and add rigidity to the membranous wall of the trachea in order to prevent intrusion of the membranous wall into the lumen of the airway.

The surgery was performed through a right fourth intercostal space thoracotomy. The posterior airway was fully exposed from the thoracic inlet to the main bronchi after the azygos vein was transected. The posterior wall of the trachea and both main bronchi were anchored to a high-density polypropylene mesh (Marlex mesh; Marlex, C.R. Bard, Inc., Covington, GA, USA) with a series of four mattress sutures of 4-0 polydioxanone II, placed in a partial thickness fashion.

The patient was discharged on the 10th postoperative day without complications. One year after the operation, the patient presented with significant symptomatic relief and improvement of her quality of life. Surveillance bronchoscopies showed a stable membranous wall with no intrusion into the lumen of the airway.

In conclusion, surgical stabilization of the airway by tracheobronchoplasty effectively and permanently corrects malacic airways. Proper surgical selection is facilitated by a short-term stent trial.


References

  1. Akgedik R, Karamanli H, Kizilirmak D, Kurt AB, Öztürk H, Yildirim BB, et al. Mounier-Kuhn syndrome (tracheo-bronchomegaly): An analysis of eleven cases. Clin Respir J. 2018;12:885–889.
  2. Gangadharan SP. Tracheobronchomalacia in adults. Semin Thorac Cardiovasc Surg, 22(2), 165–173.
  3. Odell DD, Shah A, Gangadharan SP, Majid A, Michaud G, Herth F, et al. Airway stenting and tracheobronchoplasty improve respiratory symptoms in Mounier-Kuhn syndrome. Chest. 2011;140: 867–873.
  4. Mounier-Kuhn P. Dilatation de la trachea: constatation radiographiques et bronchoscopiques. Lyon Med. 1932; 150:106–109.
  5. Krustins E. Mounier-Kuhn syndrome: a systematic analysis of 128 cases published within last 25 years. Clin Respir J. 2016;10:3–10. 

  6. Buitrago DH, Wilson JL, Parikh M, Majid A, Gangadharan S. Current concepts in severe adult tracheobronchomalacia: evaluation and treatment. J Thorac Dis. 2017;9:E57–66.

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