Intra-procedural Bronchoscopy to Prevent Bronchial Compression During Pulmonary Artery Stent Angioplasty

Abstract

Background Stenosis of the pulmonary arteries frequently occurs during staged palliation of hypoplastic left heart syndrome and variants, often necessitating stent angioplasty. A complication of stent angioplasty is compression of the ipsilateral main-stem bronchus. Following such a case, we re-evaluated our approach to PA stent angioplasty in these patients. Methods The incident case is described. A retrospective observational study of children and adults with superior(SCPC) and/or total cavopulmonary connection(TCPC) undergoing left pulmonary artery (LPA) stent angioplasty between 1/1/2005 and 5/1/2014 and subsequent chest CT was performed to assess the incidence of bronchial compression. The current strategy of employing bronchoscopy to assess bronchial compression during angioplasty is described with short-term results. Results 65 children and adults underwent LPA stent angioplasty. Other than the incident case, none had symptomatic bronchial compression. Of the total study population, 12% had subsequent CT, of which 1 subject had moderate bronchial compression. To date, 7 subjects have undergone angioplasty of LPA stenosis and bronchoscopy. In one case, stent angioplasty was not performed because of baseline bronchial compression, exacerbated during angioplasty. In the rest of cases, mild-moderate compression was seen during angioplasty. Following stent angioplasty, the resultant compression was not worse than that seen on test angioplasty. Conclusion Bronchial compression is a rare complication of stent angioplasty of the pulmonary arteries in children and adults with SCPC/TCPC. Angioplasty of the region of interest with procedural bronchoscopy can help to identify patients at risk of this complication.

Compression of the left mainstem bronchus by patent ductus arteriosus in neonates under consideration for ductal stenting

“…We briefly entertained whether compliance testing with simultaneous bronchoscopy as described in other clinical scenarios was worthwhile. However, this maneuver requires crossing the PDA with a wire, which, in our experience, can result in profound cyanosis and hemodynamic instability, especially in patients in whom the PDA is tortuous and/or the sole source of pulmonary blood flow.…”

A rare cause of wheezing in a child with pulmonary atresia

“…[6] Intraprocedural bronchoscopy is useful during specific interventional cardiology procedures as well, to avoid airway complications. [78] Backer et al . highlighted the importance of intraoperative bronchoscopy to confirm the success of the innominate arteriopexy operation as well as suggested monitoring of the right radial artery pulse to identify and prevent stenosis of the innominate artery by the suspension maneuver.…”

Pediatric pulmonology year in review 2015: Part 3

“…Bronchoscopy during pediatric pulmonary artery stent placement to detect bronchial compression during test angioplasty (without stenting) may be useful to avoid possible airway complications of this procedure. 33 This paper reported that in one of seven cases the observed bronchial compression during test angioplasty was so severe that it was decided not to place a pulmonary artery stent. Similarly, bronchoscopy may be important for treatment decisions in children with absent pulmonary valve syndrome.…”