Life-threatening airway bleeding after palliation of single ventricle congenital heart disease

Averin, Konstantin; Byrnes, Jonathan W.; Benscoter, Dan; Whiteside, Wendy; DeSena, Holly C.; Hirsch, Russel; Goldstein, Bryan H.

doi:10.1136/heartjnl-2017-311764

Cited by 10 publications

(14 citation statements)

References 23 publications

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“…Two patients died with patent airways due to non–splint‐related causes. One patient died 7 months after implantation after suffering an arrest secondary to diffuse hemoptysis, a rare, but known, complication of single ventricle anatomy . An autopsy confirmed the presence of many prominent congested submucosal vessels and abnormal dilated tortuous veins well away from the splints.…”

Section: Resultsmentioning

confidence: 96%

“…One patient died 7 months after implantation after suffering an arrest secondary to diffuse hemoptysis, a rare, but known, complication of single ventricle anatomy. 17 An autopsy confirmed the presence of many prominent congested submucosal vessels and abnormal dilated tortuous veins well away from the splints. A second patient died 10 days postoperatively with airways that were patent in the splinted region, after suffering an arrest secondary to CO 2 retention and acidosis, complicated by reactive pulmonary hypertension related to parenchymal disease in her single lung.…”

Section: Complicationsmentioning

confidence: 91%

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3D‐printed, externally‐implanted, bioresorbable airway splints for severe tracheobronchomalacia

et al. 2019

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Objective To report the clinical safety and efficacy of 3D-printed, patient-specific, bioresorbable airway splints in a cohort of critically ill children with severe tracheobronchomalacia. Methods From 2012–2018, 15 subjects received 29 splints on their trachea, right and/or left mainstem bronchi. The median age at implantation was eight months (range, 3–25 months). Nine children were female. Five subjects had a history of ECMO (extra-corporeal membrane oxygenation), and eleven required continuous sedation, six of which required paralytics to maintain adequate ventilation. Thirteen were chronically hospitalized, unable to be discharged, and seven were hospitalized their entire lives. At the time of splint implantation, one subject required ECMO, one required positive airway pressure, and 13 subjects were tracheostomy and ventilator dependent, requiring a median positive end-expiratory pressure (PEEP) of 14 cmH2O (range, 6–20 cmH20). Outcomes collected included level of respiratory support, disposition, and splint-related complications. Results At the time of discharge from our institution, at a median of 28 days’ post-implantation (range, 10–56 days), the subject on ECMO was weaned from extracorporeal support, and the subjects who were ventilated via tracheostomy had a median change in PEEP (discharge – baseline) of −2.5 cmH2O (range, −15 to 2 cmH2O, p=0.022). At median follow-up of 8.5 months (range, 0.3–77 months), all but one of the 12 surviving subjects lives at home. Of the 11 survivors who were tracheostomy dependent pre-op, one is decannulated, one uses a speaking valve, six use a ventilator exclusively at night, and three remain ventilator dependent. Conclusion This case series demonstrates the initial clinical efficacy of the 3D-printed bioresorbable airway splint device in a cohort of critically ill children with severe tracheobronchomalacia.

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Section: Resultsmentioning

confidence: 96%

Section: Complicationsmentioning

confidence: 91%

3D‐printed, externally‐implanted, bioresorbable airway splints for severe tracheobronchomalacia

et al. 2019

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Section: Discussionunclassified

“…La hemoptisis en pacientes con cardiopatía congénita cianótica puede originarse debido a colaterales aortopulmonares o a malformaciones arteriovenosas (1)(2)(3)(4)(5) . Las colaterales aortopulmonares que se encuentran en relación cercana al árbol bronquial pueden dilatarse, protruir hacia la mucosa bronquial Manejo percutáneo de hemoptisis en Fontan 188| EsSalud y romperse generando hemoptisis importante (5) . Esto puede desencadenarse de forma espontánea, ya sea por un incremento de flujo progresivo hacia las colaterales aortopulmonares, o por alguna lesión aguda o crónica de las vías aéreas, como procesos inflamatorios infecciosos o no infecciosos tales como reflujo gastroesofágico o alergias (1,2,5) .…”

Section: Discussionunclassified

“…La recurrencia de la hemoptisis suele ser muy frecuente con manejo médico, alcanzando el 60% (3,5) , e incluso mayor en casos de mantener terapia anticoagulante como en el caso de nuestra paciente, que la necesitaba por ser portadora de prótesis mecánica. El impacto de la hemoptisis va en proporción a su severidad, generando en muchos casos necesidad de ventilación mecánica o múltiples transfusiones; alcanza una mortalidad de 22% en casos severos y de 71% en hemoptisis masiva (4)(5)(6) .…”

Section: Discussionunclassified

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Percutaneous management of severe hemoptysis in a patient after Fontan surgery

Alcalá-Marcos

Gonzalez

Flores-Gamero³

et al. 2020

Arch Peru Cardiol Cir Cardiovasc

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Se presenta el caso de una paciente con antecedente de ventrículo único por atresia tricuspídea, doble vía de salida del ventrículo izquierdo e hipoplasia del anillo de la arteria pulmonar. La paciente fue tratada con cirugía de Glenn a los 7 años de vida y, a los 16, se le realizó cirugía de Fontan extracardíaco fenestrado. Luego de 1 mes de realizada la cirugía presentó hemoptisis severa sin adecuada respuesta al manejo médico. Se realizó cierre percutáneo de las fístulas aortopulmonares con coils, con evolución favorable, sin presentar recurrencias de hemoptisis.

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Systemic-to-Pulmonary Collateral Flow Correlates with Clinical Condition Late After the Fontan Procedure

et al. 2020

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Life-threatening airway bleeding after palliation of single ventricle congenital heart disease

Cited by 10 publications

References 23 publications

3D‐printed, externally‐implanted, bioresorbable airway splints for severe tracheobronchomalacia

3D‐printed, externally‐implanted, bioresorbable airway splints for severe tracheobronchomalacia

Percutaneous management of severe hemoptysis in a patient after Fontan surgery

Systemic-to-Pulmonary Collateral Flow Correlates with Clinical Condition Late After the Fontan Procedure

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