AORTOPEXY (TRACHEOMALACIA)

REASON FOR VISIT

• Tracheomalacia
• Expiratory stridor (laryngeal crow)
• Feeding difficulties
• Hoarseness
• Aphonia
• Prolonged intubation
• Tracheostomy
• Chest trauma
• Recurrent tracheobronchitis
• Cartilage disorder (relapsing polychondritis)
• Lung resection
• Reflex apnea
• Recurrent pneumonia
• Intermittent respiratory obstruction
• Inability to extubate airway

RISK ASSESSMENT

• Old age
• Prior heart surgeries
• Hyper tension
• Diabetes
• Kidney diseases
• Allergy to medication/anesthesia

PREPARATION OF THE PATIENT:

• Blood tests
• Urinalysis
• Chest X-ray
• Cinefluoroscopy
• Ultrafast CT scan
• Ventilating laryngoscope
• Telescoping bronchoscopy
• Flexible bronchoscopy
• Nothing is taken by mouth 6hrs before surgery
• Prophylactic Antibiotics were given
POSITION OF THE PATIENT:

Supine position

ANESTHESIA:
General anesthesia

THE PROCEDURE

TRACHEOSTOMY

• The patient was in the supine position; the neck was placed in
moderate hypertension.
• Cricoid cartilage and the thyroid isthmus was identified
• A transverse incision was made over the trachea
• The pretracheal fascia was divided, and the tracheal rings were
counted.
• The third tracheal ring was identified and divided in the midline;
• the vertical tracheal incision was given
• The second and fourth rings divided as well.
• No amount of tracheal tissue was removed during the procedure.
• The stoma was enlarged by gently spreading the blades of the
hemostat against the margins of the tracheal opening.
• A lubricated tracheostomy tube was inserted through this
opening.
• Transtracheal injection of lidocaine was given
• The tube was secured to the neck and adjusted
• The skin opening was closed with sutures

PERCUTANEOUS TRACHEOSTOMY

• After preparing the patient's neck, a 3-cm longitudinal incision

was made over the second and third cartilaginous tracheal rings.
• The endotracheal tube was withdrawn somewhat, and the
introducer catheter was advanced into the tracheal lumen.
• The intratracheal location was confirmed either under
bronchoscopic guidance /though the withdrawal of air bubbles.
• The introducer catheter was advanced into the trachea, and the
syringe and steel needle of the introducer catheter are
withdrawn.
• The flexible J-tipped guide wire was inserted into the trachea
through the introducer catheter, and the catheter was removed.
• An introducing dilator was advanced into the trachea until the
black positioning mark.
 • The tapered sequential dilators were used successively to dilate
the anterior tracheal wall to a diameter larger than the
tracheostomy tube.
• A tracheostomy tube over the tapered dilator was advanced into
the trachea, and dilator, guiding catheter, and wire guide are
removed.
• The inner cannula was inserted, and the patient was attached to
the ventilator.
• Skin was closed with sutures

AORTOPEXY

• The patient was positioned with the left shoulder elevated at a

30- to 45-degree angle.
• A bronchoscopy was performed
• A left anterior thoracotomy, partial thymectomy was done
• The apex of the left upper lobe was retracted inferiorly and
posteriorly.
• The search for the vascular ring was conducted, and the
esophagus was examined.
• A single row of interrupted monofilament sutures was placed
from the arch of the aorta to the undersurface of the sternum
and tied down to displace the arch anteriorly.
• The bites into the aorta deep enough to include media and
adventitia;
• The sutures are passed through the sternum to a subcutaneous
pocket.
• The aorta was fixed with sternum
• The cut rib is replaced and held in place with special materials
• Layers of muscle and skin were stitched

DURATION
_____________hrs

AFTER PROCEDURE

• Patient was shifted to the I.C.U

• Patient was on ventilation
• Heart sounds, oxygenation, and the ECG were monitored.
• Chest tubes are checked to ensure that they're draining
properly and there is no hemorrhage.
• The skin around the drainage tube to the thoracic cavity kept
clean, and the tube must be kept unblocked
POSTOPERATIVE CARE

• Take antibiotic medicine as prescribed

• Take pain medication as prescribed
• Don’t do strenuous exercise
• Start chest exercises and chest physical therapy

COMPLICATIONS

• Hemorrhage
• Postoperative aneurysm formation
• Chronic ventilatory insufficiency
• Infection
• Accidental endotracheal extubation
• Extratracheal dilator position
• Esophageal perforation
• Mucosal endobronchial flap