Let's learn about TBM and the surgeries

Tracheomalacia (TM)

In a normal trachea, there is cartilage on 3 sides of the trachea with a small section on the posterior (back) that does not.  Tracheomalacia (TM) can happen in different ways but the most common is that the posterior of the trachea collapses in on exhale usually because the trachea is shaped a little different and that uncartilaged area is bigger than normal.  

 When assessing the trachea, they look for a few things when classifying TM, like location, character and severity.  

The location is important because each area of the airway has different structures surrounding that can cause issues and could have a different solution.  

The character is how the airway collapses.  Landrie's was classified as "D - Combined" in the image below.  The posterior was collapsing in along with an anterior compression from the innominate artery

The severity of the collapse is the amount the airway collapses or is compressed.  They like to assess this with regular breathing and forceful breathing like a cough.  Landrie's was almost all the way with regular breathing and 100% with forceful breathing. 

Now that we know a little bit more about TM and what causes it.  Here's a little info on the surgeries that Landrie was going to have done. 

Posterior Tracheopexy

Dr. Jennings created this surgery about 3 years ago and as of now he is the only one that does it but there is talk of training other doctors. 

In very simple terms…. they move the esophagus over a little and suture the posterior wall of the trachea to the spine.  This holds the trachea open.  

 

Descending Aortopexy

 Landrie’s Left mainstem bronchus was severely compressed between the Pulmonary Artery and Descending Aorta. In order to relieve the compression, they do a Descending Aortopexy....move and suture the descending aorta to the spine. 

 

Dr. Jennings talks about a lot of this stuff at Grand Rounds.  Here is a link to the youtube video of it.  It is a very interesting listen.  A couple of his fellow doctors in his team also talk.                              

Dr. Jennings Grand Rounds - Tracheomalacia and complex congenital airway problems and treatment