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An imaging study on tracheomalacia in infants with esophageal atresia: the degree of tracheal compression by the brachiocephalic artery is a good indicator for therapeutic intervention

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Abstract

Purpose

Tracheomalacia (TM) is a frequent complication after esophageal atresia (EA) repair. This study aimed to review patients who underwent aortopexy for TM after EA repair and to compare their imaging features.

Methods

The patients who underwent thoracoscopic EA repair and contrast-enhanced computed tomography (CECT) at our hospital between 2013 and 2020 were retrospectively reviewed. The ratio of the lateral and anterior–posterior diameter of the trachea (LAR) where the brachiocephalic artery (BCA) crosses the trachea was defined. The LAR of the patients who underwent CECT for asymptomatic pulmonary disease was set as a normal reference. The Z-score of each LAR was calculated and compared between the patients that did or did not undergo aortopexy.

Results

A total of 51 patients represented the controls, 5 patients underwent aortopexy, and 12 patients were discharged without surgery. The mean LARs in the patients who underwent aortopexy, did not undergo aortopexy, and controls were 3.54, 1.54, and 1.15, respectively. The mean Z-score of the aortopexy group was 21.2. After successful aortopexy, each patient’s LAR decreased to < 1.5.

Conclusion

Aortopexy was preferred if the trachea was compressed by the BCA. The LAR is a useful indicator for predicting the therapeutic effect of aortopexy.

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Authors and Affiliations

  1. Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan

    Wataru Sumida, Takahisa Tainaka, Chiyoe Shirota, Kazuki Yokota, Satoshi Makita, Aitaro Takimoto, Akihiro Yasui, Masamune Okamoto, Yoichi Nakagawa, Akinari Hinoki & Hiroo Uchida

Authors
  1. Wataru Sumida
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  2. Takahisa Tainaka
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  3. Chiyoe Shirota
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  4. Kazuki Yokota
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  5. Satoshi Makita
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  6. Aitaro Takimoto
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  7. Akihiro Yasui
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  8. Masamune Okamoto
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  9. Yoichi Nakagawa
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  10. Akinari Hinoki
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  11. Hiroo Uchida
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Corresponding author

Correspondence to Wataru Sumida.

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Sumida, W., Tainaka, T., Shirota, C. et al. An imaging study on tracheomalacia in infants with esophageal atresia: the degree of tracheal compression by the brachiocephalic artery is a good indicator for therapeutic intervention. Pediatr Surg Int 37, 1719–1724 (2021). https://doi.org/10.1007/s00383-021-04985-0

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  • DOI: https://doi.org/10.1007/s00383-021-04985-0

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