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Search on : Tracheobronchomalacia [Words]
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[PMID]: 29524603
[Au] Autor:Shieh HF; Smithers CJ; Hamilton TE; Zurakowski D; Visner GA; Manfredi MA; Jennings RW; Baird CW
[Ad] Address:Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115.
[Ti] Title:Descending Aortopexy and Posterior Tracheopexy for Severe Tracheomalacia and Left Mainstem Bronchomalacia.
[So] Source:Semin Thorac Cardiovasc Surg;, 2018 Mar 07.
[Is] ISSN:1532-9488
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVE: Posterior descending aortopexy can relieve posterior intrusion of the left mainstem bronchus that may limit the effectiveness of posterior tracheobronchopexy. We review outcomes of patients undergoing both descending aortopexy and posterior tracheopexy for severe tracheobronchomalacia with posterior intrusion and left mainstem compression to determine if there were resolution of clinical symptoms and bronchoscopic evidence of improvement in airway collapse. METHODS: All patients who underwent both descending aortopexy and posterior tracheopexy from October 2012 to October 2016 were retrospectively reviewed. Clinical symptoms, tracheomalacia scores based on standardized dynamic airway evaluation by anatomical region, and persistent airway intrusion requiring reoperation were collected. Data were analyzed by Wald and Wilcoxon signed-ranks tests. RESULTS: 32 patients underwent descending aortopexy and posterior tracheopexy at median age 18 months (IQR 6-40 months). Median follow up was 3 months (IQR 1-7 months). There were statistically significant improvements in clinical symptoms postoperatively, including cough, noisy breathing, prolonged and recurrent respiratory infections, ventilator dependence, blue spells, and brief resolved unexplained events (BRUEs) (all P<.001), as well as exercise intolerance (P=.033), transient respiratory distress requiring positive pressure (P=.003), and oxygen dependence (P=.007). Total tracheomalacia scores improved significantly (P<.001), with significant segmental improvements in the middle (P=.003) and lower (P<.001) trachea, and right (P=.011) and left (P<.001) mainstem bronchi. 2 patients (6%) had persistent airway intrusion requiring reoperation with anterior aortopexy and/or tracheopexy. CONCLUSIONS: Descending aortopexy and posterior tracheopexy are effective in treating severe tracheobronchomalacia and left mainstem intrusion with significant improvements in clinical symptoms and degree of airway collapse on bronchoscopy.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:Publisher

  2 / 391 MEDLINE  
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[PMID]: 29514258
[Au] Autor:Rijnberg FM; Butler CR; Bieli C; Kumar S; Nouraei R; Asto J; McKavanagh E; de Coppi P; Muthialu N; Elliott MJ; Hewitt RJ
[Ad] Address:Tracheal Team, Great Ormond Street Hospital, London, UK.
[Ti] Title:Aortopexy for the treatment of tracheobronchomalacia in 100 children: a 10-year single-centre experience.
[So] Source:Eur J Cardiothorac Surg;, 2018 Mar 05.
[Is] ISSN:1873-734X
[Cp] Country of publication:Germany
[La] Language:eng
[Ab] Abstract:OBJECTIVES: Our study describes and analyses the results from aortopexy for the treatment of airway malacia in children. METHODS: Demographic data, characteristics and preoperative, operative and outcome details, including the need for reintervention, were collected for children undergoing aortopexy between 2006 and 2016. RESULTS: One hundred patients [median age 8.2 months, interquartile range (IQR) 3.3-26.0 months] underwent aortopexy. Sixty-four (64%) patients had tracheomalacia (TM) only, 24 (24%) patients had TM extending into their bronchus (tracheobronchomalacia) and 11 (11%) patients had bronchomalacia. Forty-one (41%) children had gastro-oesophageal reflux disease, of which 17 (41%) children underwent a Nissen fundoplication. Twenty-eight (28%) children underwent a tracheo-oesophageal fistula repair prior to aortopexy (median 5.7 months, IQR 2.9-17.6 months). The median duration of follow-up was 5.3 years (IQR 2.9-7.5 years). Thirty-five (35%) patients were on mechanical ventilatory support before aortopexy. Twenty-seven (77%) patients could be safely weaned from ventilator support during the same admission after aortopexy (median 2 days, IQR 0-3 days). Fourteen patients required reintervention. Overall mortality was 16%. Multivariable analysis revealed preoperative ventilation (P = 0.004) and bronchial involvement (P = 0.004) to be adverse predictors of survival. Only bronchial involvement was a predictor for reintervention (P = 0.012). CONCLUSIONS: Aortopexy appears to be an effective procedure in the treatment of children with severe airway malacia. Bronchial involvement is associated with adverse outcome, and other procedures could be more suitable. For the treatment of severe airway malacia with isolated airway compression, we currently recommend aortopexy to be considered.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180307
[Lr] Last revision date:180307
[St] Status:Publisher
[do] DOI:10.1093/ejcts/ezy076

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[PMID]: 29428562
[Au] Autor:Gerhardt B; Leesman L; Burra K; Snowball J; Rosenzweig R; Guzman N; Ambalavanan M; Sinner D
[Ad] Address:Division of Neonatology and Pulmonary Biology, CCHMC, University of Cincinnati, College of Medicine and University Honors Program, Cincinnati, OH 45229, United States of America.
[Ti] Title:Notum attenuates Wnt/ß-catenin signaling to promote tracheal cartilage patterning.
[So] Source:Dev Biol;, 2018 Feb 09.
[Is] ISSN:1095-564X
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Tracheobronchomalacia (TBM) is a common congenital disorder in which the cartilaginous rings of the trachea are weakened or missing. Despite the high prevalence and clinical issues associated with TBM, the etiology is largely unknown. Our previous studies demonstrated that Wntless (Wls) and its associated Wnt pathways are critical for patterning of the upper airways. Deletion of Wls in respiratory endoderm caused TBM and ectopic trachealis muscle. To understand mechanisms by which Wls mediates tracheal patterning, we performed RNA sequencing in prechondrogenic tracheal tissue of Wls ;Shh embryos. Chondrogenic Bmp4, and Sox9 were decreased, while expression of myogenic genes was increased. We identified Notum, a deacylase that inactivates Wnt ligands, as a target of Wls induced Wnt signaling. Notum's mesenchymal ventral expression in prechondrogenic trachea overlaps with expression of Axin2, a Wnt/ß-catenin target and inhibitor. Notum is induced by Wnt/ß-catenin in developing trachea. Deletion of Notum activated mesenchymal Wnt/ß-catenin and caused tracheal mispatterning of trachealis muscle and cartilage as well as tracheal stenosis. Notum is required for tracheal morphogenesis, influencing mesenchymal condensations critical for patterning of tracheal cartilage and muscle. We propose that Notum influences mesenchymal cell differentiation by generating a barrier for Wnt ligands produced and secreted by airway epithelial cells to attenuate Wnt signaling.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180307
[Lr] Last revision date:180307
[St] Status:Publisher

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[PMID]: 29237524
[Au] Autor:Li L; Chen Q; Zhang F; Zhu SG; Hu CL; Wu AM
[Ad] Address:Department of Respiration, Jiangxi Children's Hospital, Nanchang 330000, China. nclilan@163.com.
[Ti] Title:[Characteristics of tidal breathing pulmonary function in children with tracheobronchomalacia].
[So] Source:Zhongguo Dang Dai Er Ke Za Zhi;19(12):1248-1251, 2017 Dec.
[Is] ISSN:1008-8830
[Cp] Country of publication:China
[La] Language:chi
[Ab] Abstract:OBJECTIVE: To investigate the characteristics of tidal breathing pulmonary function in children with tracheobronchomalacia (TBM). METHODS: In this study, 30 children who were diagnosed with TBM using electronic bronchoscopy were enrolled in the observation group; 30 healthy children were recruited in the normal control group. For individuals in each group, the assessment of tidal breath pulmonary function was performed at diagnosis and 3, 6, 9, and 12 months after diagnosis. RESULTS: There were no significant differences in tidal volume, inspiratory time, expiratory time, and inspiratory to expiratory ratio between the two groups (P>0.05). Compared with the control group, the observation group had a significantly higher respiratory rate and significantly lower ratio of time to peak tidal expiratory flow to total expiratory time (TPTEF/TE) and ratio of volume to peak tidal expiratory flow to total expiratory volume (VPTEF/VE). There was a time-dependent increase in TPTEF/TE and VPTEF/VE for TBM children from the time of initial diagnosis to 12 months after diagnosis. CONCLUSIONS: Tidal breathing pulmonary function has characteristic changes in children with TBM. Tidal breathing pulmonary function tends to be recovered with increased age in children with TBM.
[Mh] MeSH terms primary: Lung/physiopathology
Respiration
Tidal Volume
Tracheobronchomalacia/physiopathology
[Mh] MeSH terms secundary: Age Factors
Female
Humans
Infant
Male
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180306
[Lr] Last revision date:180306
[Js] Journal subset:IM
[Da] Date of entry for processing:171215
[St] Status:MEDLINE

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[PMID]: 29465600
[Au] Autor:Ryu C; Boffa D; Bramley K; Pisani M; Puchalski J
[Ad] Address:Yale School of Medicine, Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine.
[Ti] Title:A novel endobronchial approach to massive hemoptysis complicating silicone Y-stent placement for tracheobronchomalacia: A case report.
[So] Source:Medicine (Baltimore);97(8):e9980, 2018 Feb.
[Is] ISSN:1536-5964
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:RATIONALE: Airway stabilization for severe, symptomatic tracheobronchomalacia (TBM) may be accomplished by silicone Y-stent placement. Common complications of the Y-stent include mucus plugging and granulation tissue formation. PATIENT CONCERNS: We describe a rare case of massive hemoptysis originating from a silicone Y-stent placed for TBM. DIAGNOSES: An emergent bronchoscopy showed an actively bleeding, pulsatile vessel at the distal end of the left bronchial limb of the Y-stent. It was felt that the bleeding was caused by, or at least impacted by, the distal left bronchial limb of the Y-stent eroding into the airway wall. INTERVENTIONS: We hypothesized that placement of oxidized regenerated cellulose (ORC) would provide initial hemostasis, and the subsequent placement of a biocompatible surgical sealant would lead to definitive resolution. OUTCOMES: ORC provided sufficient hemostasis and the subsequent synthetic polymer reinforced the tissue for complete cessation of the bleed. LESSONS: The combined use of ORC and a biocompatible surgical sealant provided long-term management for life-threatening hemoptysis, and potentially morbid procedures such as embolization or surgery were avoided by advanced endobronchial therapy.
[Mh] MeSH terms primary: Bronchoscopy/methods
Hemoptysis/surgery
Hemostasis, Endoscopic/methods
Stents/adverse effects
Tracheobronchomalacia/surgery
[Mh] MeSH terms secundary: Aged
Cellulose, Oxidized/administration & dosage
Female
Hemoptysis/etiology
Hemostatics/administration & dosage
Humans
Prosthesis Implantation/instrumentation
Prosthesis Implantation/methods
Silicones
Tracheobronchomalacia/complications
[Pt] Publication type:CASE REPORTS; JOURNAL ARTICLE
[Nm] Name of substance:0 (Cellulose, Oxidized); 0 (Hemostatics); 0 (Silicones)
[Em] Entry month:1803
[Cu] Class update date: 180302
[Lr] Last revision date:180302
[Js] Journal subset:AIM; IM
[Da] Date of entry for processing:180222
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009980

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[PMID]: 29433717
[Au] Autor:Hammond K; Ghori UK; Musani AI
[Ad] Address:Division of Pulmonary and Critical Care Medicine, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA.
[Ti] Title:Tracheobronchomalacia and Excessive Dynamic Airway Collapse.
[So] Source:Clin Chest Med;39(1):223-228, 2018 Mar.
[Is] ISSN:1557-8216
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Tracheobronchomalacia (TBM) and excessive dynamic airway collapse (EDAC) are more frequently being recognized as the etiology of multiple types of respiratory complaints from chronic cough to exertional syncope to recurrent infections. Identification of these conditions requires a high suspicion, as well as a thorough history and physical examination. Dynamic computed tomography imaging and bronchoscopic evaluation are integral in achieving an accurate diagnosis. Once recognized, treatment ranges from addressing underlying contributing conditions to surgical stabilization of the airway. Referral to an institution familiar with the evaluation and treatment of TBM/EDAC is essential for the appropriate management of these conditions.
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Em] Entry month:1802
[Cu] Class update date: 180213
[Lr] Last revision date:180213
[St] Status:In-Data-Review

  7 / 391 MEDLINE  
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[PMID]: 27568138
[Au] Autor:Ragalie WS; Mitchell ME
[Ad] Address:Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
[Ti] Title:Advances in Surgical Treatment of Congenital Airway Disease.
[So] Source:Semin Thorac Cardiovasc Surg;28(1):62-8, 2016.
[Is] ISSN:1532-9488
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Tracheobronchomalacia (TBM) is frequently present in infants and children with congenital heart disease (CHD). Infants with CHD and TBM appear to do worse than those without TBM. The principle of operative intervention for TBM is to improve function of the airway and clinical status. When indicated, conventional surgical options include tracheostomy, aortopexy, tracheoplasty, and anterior tracheal suspension. There is no consensus on the optimal treatment of severe tracheobonchomalacia, which can be associated with a mortality rate as high as 80%. Congenital tracheal stenosis is also frequently associated with CHD (vascular rings, atrioventricular canal defects, and septal defects) and may require concomitant repair. Repair of tracheal stenosis is often associated with distal TBM. This article addresses new techniques that can be performed in corrective surgery for both TBM and congenital tracheal stenosis.
[Mh] MeSH terms primary: Bronchi/surgery
Constriction, Pathologic/surgery
Thoracic Surgical Procedures
Trachea/abnormalities
Trachea/surgery
Tracheobronchomalacia/surgery
[Mh] MeSH terms secundary: Bronchi/abnormalities
Bronchi/physiopathology
Constriction, Pathologic/diagnosis
Constriction, Pathologic/mortality
Constriction, Pathologic/physiopathology
Diffusion of Innovation
History, 20th Century
History, 21st Century
Humans
Recovery of Function
Severity of Illness Index
Thoracic Surgical Procedures/history
Thoracic Surgical Procedures/trends
Trachea/physiopathology
Tracheobronchomalacia/diagnosis
Tracheobronchomalacia/mortality
Tracheobronchomalacia/physiopathology
Treatment Outcome
[Pt] Publication type:HISTORICAL ARTICLE; JOURNAL ARTICLE; REVIEW
[Em] Entry month:1703
[Cu] Class update date: 180126
[Lr] Last revision date:180126
[Js] Journal subset:IM
[Da] Date of entry for processing:160829
[St] Status:MEDLINE

  8 / 391 MEDLINE  
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[PMID]: 29224761
[Au] Autor:Propst EJ; Zawawi F; Kirsch RE; Honjo O
[Ad] Address:Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. Electronic address: Evan.propst@utoronto.ca.
[Ti] Title:Direct tracheobronchopexy via left lateral thoracotomy for severe tracheobronchomalacia.
[So] Source:Int J Pediatr Otorhinolaryngol;103:32-35, 2017 Dec.
[Is] ISSN:1872-8464
[Cp] Country of publication:Ireland
[La] Language:eng
[Ab] Abstract:An infant with pulmonary atresia/ventricular septal defect/major aortopulmonary collateral arteries underwent unifocalization, ventriculoseptal defect closure and placement of a right ventricle to pulmonary artery conduit via median sternotomy. Aortopexy and pulmonary arteriopexy via redo sternotomy were insufficient to allow weaning of continuous positive airway pressure and he required direct tracheobronchopexy via left lateral thoracotomy to alleviate posterior trachealis intrusion along the length of the trachea and left main bronchus. He also underwent laryngotracheoplasty with placement of a posterior costal cartilage graft for bilateral vocal cord paralysis. The patient was weaned from positive pressure and discharged in stable condition.
[Mh] MeSH terms primary: Bronchi/surgery
Thoracotomy/methods
Trachea/surgery
Tracheobronchomalacia/surgery
[Mh] MeSH terms secundary: Bronchoscopy
Collateral Circulation
Heart Septal Defects, Ventricular/surgery
Humans
Infant
Male
Pulmonary Artery/surgery
Pulmonary Atresia/surgery
Tomography, X-Ray Computed
[Pt] Publication type:CASE REPORTS; JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 171226
[Lr] Last revision date:171226
[Js] Journal subset:IM
[Da] Date of entry for processing:171212
[St] Status:MEDLINE

  9 / 391 MEDLINE  
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[PMID]: 29239780
[Au] Autor:Diaz Milian R; Castresana MR
[Ad] Address:Augusta University, Medical College of Georgia, Augusta, GA. Electronic address: rdiazmilian@augusta.edu.
[Ti] Title:Recurrent Failure of Positive-Pressure Ventilation: Machine Malfunction or a Rare, Unexpected Cause?
[So] Source:J Cardiothorac Vasc Anesth;, 2017 Oct 20.
[Is] ISSN:1532-8422
[Cp] Country of publication:United States
[La] Language:eng
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 171214
[Lr] Last revision date:171214
[St] Status:Publisher

  10 / 391 MEDLINE  
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[PMID]: 29174374
[Au] Autor:Wallis C; McLaren CA
[Ad] Address:Department of Respiratory Paediatrics, Great Ormond Street Hospital for Children, London, UK. Electronic address: Colin.wallis@gosh.nhs.uk.
[Ti] Title:Tracheobronchial stenting for airway malacia.
[So] Source:Paediatr Respir Rev;, 2017 Oct 13.
[Is] ISSN:1526-0550
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:Tracheobronchomalacia is a rare but clinically troublesome condition in paediatrics. The softening of the major airways - which can include some or all of the tracheobronchial tree can lead to symptoms ranging from the minor (harsh barking cough, recurrent chest infections) to severe respiratory difficulties including prolonged ventilator support and 'near death attacks'. The causes are broadly divided into intrinsic softening of the airway wall which is considered a primary defect (e.g. syndromes; post tracheo-oesophageal fistula repair; extreme prematurity) or secondary malacia due to external compression from vascular structures or cardiac components. These secondary changes can persist even when the external compression is relieved, for example, following the repair of a pulmonary artery sling or double aortic arch. For children with severe clinical symptoms attributed to malacia, consideration is given to possible surgical remedies such as an aortopexy for short limited areas of malacia, or long term positive pressure support with CPAP either by non invasive or tracheostomy interface. More recently the role of stenting in children is receiving attention, especially with the development of newer techniques such as bioabsorbable stents which buy time for a natural history of improvement in the malacia to occur. This paper reviews the stents available and discusses the pros and cons of stenting in paediatric airway malacia.
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Em] Entry month:1711
[Cu] Class update date: 171127
[Lr] Last revision date:171127
[St] Status:Publisher


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