Management of tracheomalacia in an infant with Tetralogy of
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Most infants with tracheomalacia do not need specific therapy as it usually resolves spontaneously by the age of 1–2 years. Severe forms of tracheomalacia characterized by recurrent respiratory infections require active treatment which includes chest physiotherapy, long term intubation or tracheostomy. Aortopexy seems to be the treatment of choice for secondary and even primary forms of severe tracheomalacia. Itentails tracking and suturing the anterior wall of the aorta to the posterior surface of the sternum. Consequently, the anterior wall of the trachea is also pulled forward preventing its collapse. A 3-month-old girl baby who was on ventilatory support for 2 months due to severe tracheomalacia associated with a cyanotic congenital heart disease underwent intracardiac repair and aortopexy along with Lecompte's procedure as all the conservative measures to wean off the ventilator failed. The baby was extubated on the third post-operative day and the post-operative period was uneventful.

A 3-month-old female baby weighing 5.9 kg was referred to the paediatric intensive care unit for tracheomalacia. Baby was intubated at 20 days of age for respiratory distress and cyanosis. Multiple trials to extubate the child failed and she became ventilator dependent. The baby was ventilated with synchronized intermittent mandatory ventilation (SIMV) pressure support mode with peak inspiratory pressure 30 cm of H2O. Her saturation was 90–92% with FiO2 of 0.5, blood pressure and heart rate were within normal limits. The baby had multiple episodes of desaturation which was treated with positive pressure ventilation using a manual resuscitation bag. Echocardiogram revealed a congenital cyanotic heart disease with a perimembranous ventricular septal defect, moderate infundibular pulmonary stenosis and aortic override of 40%. Computed tomographic scan of the thorax showed consolidation changes involving the apical segments of right upper lobe, lateral segment of right middle lobe, apical and posterior basal segments of right lower lobe. Dynamic reconstruction of the computed tomographic scan showed tracheal narrowing just above the level of the carina [Figure 1]. The child was posted for intracardiac repair with tracheal reconstruction with aortopexy.....