During the past 7 years, 41 infants were treated for
tracheomalacia. The etiology was primary/congenital in 28 patients and secondary/acquired in 16 patients, of which three patients were originally in the primary group. The primary group consisted of patients with pulsatile
tracheomalacia but normal vascular anatomy, idiopathic disease, or
tracheomalacia associated with
tracheoesophageal fistula. The secondary group consisted of patients with tracheal compression due to great vessel abnormalities, or
tracheostomy-
tracheomalacia. Diagnosis was made by bronchoscopic demonstration of major (greater than 40%) collapse of the trachea. Treatment consisted of
conservative therapy,
tracheostomy, aortopexy, or tracheal reconstruction. The 15 patients with mild primary
tracheomalacia treated conservatively had gradual resolution of symptoms by the age 2 years. All five patients with primary
tracheomalacia treated by
tracheostomy developed secondary
tracheomalacia and/or
cicatrix at the
tracheostomy site. In the 9 patients with primary
tracheomalacia treated by aortopexy, 5 are symptom free, 1 is improved, 1 had recurrent
apnea, and 2 died, 1 from unrelated complications. Of the 10 patients in the acquired group treated by aortopexy, 6 were cured, 2 were improved, and 2 failed. Of 6 patients with
tracheostomy-
tracheomalacia, 3 were eventually extubated, 1 had major reconstruction, and 2 had
tracheostomies when lost to follow-up at 1 and 5 years. Our conclusions are that, when feasible,
conservative therapy in milder cases is preferred, and no perfect operation currently exists for severe
tracheomalacia although aortopexy may have less long-term morbidity than
tracheostomy.