Tracheoplasty for Expiratory Collapse of Central Airways

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Presentation transcript:

Tracheoplasty for Expiratory Collapse of Central Airways Cameron D. Wright, MD, Hermes C. Grillo, MD, Zane T. Hammoud, MD, John C. Wain, MD, Henning A. Gaissert, MD, Victor Zaydfudim, MD, Douglas J. Mathisen, MD The Annals of Thoracic Surgery Volume 80, Issue 1, Pages 259-266 (July 2005) DOI: 10.1016/j.athoracsur.2005.01.032 Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) Expiratory (E) and (B) inspiratory (I) computed tomographic scans of a patient with intrathoracic tracheomalacia associated with chronic obstructive pulmonary disease. Difference in cross-sectional area is marked. The Annals of Thoracic Surgery 2005 80, 259-266DOI: (10.1016/j.athoracsur.2005.01.032) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Three dimensional computed tomographic reconstructions of trachea and main bronchi in a 57-year-old man with severely symptomatic malacia of the intrathoracic trachea and main bronchi. (A) Anterior view showing transition from circular cervical trachea through triangular shape to flattened cartilages distally. (B) Oblique view shows ridged membranous wall. The Annals of Thoracic Surgery 2005 80, 259-266DOI: (10.1016/j.athoracsur.2005.01.032) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Oblique spot films from fluoroscopy in the same patient as in Figure 2. (A) Inspiratory. (B) Expiratory. The Annals of Thoracic Surgery 2005 80, 259-266DOI: (10.1016/j.athoracsur.2005.01.032) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Bronchoscopic views in a patient with severely symptomatic tracheomalacia. (A) Inspiration, lower trachea. (B) Expiration at same site. (C) Postoperative examination showed stable, open airway. The posterior wall is fixed to the Marlex splint by fibrosis. The Annals of Thoracic Surgery 2005 80, 259-266DOI: (10.1016/j.athoracsur.2005.01.032) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Diagrams of posterior splinting procedure for expiratory tracheobronchial collapse. (A) Marlex strip of appropriate width is sutured to the posterior membranous tracheal wall from the apex of the thorax to the carina. Successive rows of sutures are placed as described in the text. Dots indicate general placement of sutures. Dashed lines indicate placement of Marlex strips. (B) Cross-sectional diagram showing placement and spacing of sutures. (C) When tied, sutures pull the cartilage into more nearly normal C configurations and quilt the widened membranous wall to the Marlex. (Reproduced with permission of the artist, from Grillo HC, Surgery of the Trachea and Bronchi, BC Decker, Hamilton, Ontario (Canada) 2004:647.) The Annals of Thoracic Surgery 2005 80, 259-266DOI: (10.1016/j.athoracsur.2005.01.032) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Box plot of peak expiratory flow rate (% predicted) before and after tracheoplasty. The horizontal lines denote the 10th, 25th, 50th (median), 75th, and 90th percentiles. The open circles denote the highest and lowest peak flow. (PEF = peak expiratory flow.) The Annals of Thoracic Surgery 2005 80, 259-266DOI: (10.1016/j.athoracsur.2005.01.032) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 7 Flow volume curves in a 57-year-old man with 7 years of progressive dyspnea, wheezing, cough, and respiratory infections. Preoperative on the left; two months postoperative on the right. Pulmonary function figures listed in data on the fourth patient in Table 1. The Annals of Thoracic Surgery 2005 80, 259-266DOI: (10.1016/j.athoracsur.2005.01.032) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 8 Computed tomographic scans in inspiration (A) and expiration (B) after splinting procedure in the patient in Figure 7. The now more normally shaped trachea maintains an open lumen throughout. Note thickening posterior to the trachea due to scar formation incorporating the Marlex strip. The Annals of Thoracic Surgery 2005 80, 259-266DOI: (10.1016/j.athoracsur.2005.01.032) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions