Between 1986 and 1988 aortopexy was carried out on 12 patients with primary tracheomalacia and five with tracheobronchomalacia; their median age was 5 months (1 month-7 years). All patients had stridor, 14 had had cyanotic and apnoeic episodes, and 10 had had 'death' attacks. Eight patients (47%) had associated gastro-oesophageal reflux. Six patients (35%) were helped by aortopexy alone, and a further five (29%) improved with a combination of aortopexy and antireflux treatment. Four patients required tracheostomy, one of whom died. Aortopexy failed if gastro-oesophageal reflux was present. We recommend aggressive treatment of reflux combined with aortopexy in patients with primary tracheomalacia and tracheobronchomalacia.