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Erschienen in:
28.09.2015 | Original Paper
Bronchial compression following pulmonary artery stenting in single ventricle lesions: how to prevent, and how to decompress
Erschienen in: Clinical Research in Cardiology | Ausgabe 4/2016
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Objectives
To assess airway compression during pulmonary artery (PA) intervention in single ventricle (SV) palliation.
Background
SV lesions with a prominent neo-aortic root are considered a high risk for branch PA and/or bronchial stenosis. PA stenting is well established, but may result in ipsilateral bronchial compression.
Methods
Single-centre retrospective analysis of 19 palliated SV patients with branch PA stenosis and close proximity to the ipsilateral main bronchus who underwent cardiac catheterisation at a median age and weight of 8.5 years (0.5–25) and 16.5 kg (6–82) between 12/2011 and 05/2015.
Results
Two of the 19 patients suffered an almost-closed left-main bronchus (LMB) following PA stenting. Fortunately, LMB decompression succeeded in both those patients by re-shaping the PA stents by compressing the chest while splinting the LMB with an inflated balloon. To prevent the other 17 patients from suffering this serious complication, we adopted a thorough preparation strategy: 13 patients underwent safe simultaneous bronchoscopy and cardiac catheterisation; in the remaining 4 patients CT-angiography enabled accurate risk evaluation prior to re-catheterisation.
Conclusions
In SV lesions accompanied by branch PA stenosis, thorough preparation via cross-sectional imaging is mandatory, including simultaneous bronchoscopy and cardiac catheterisation in selected cases, to rule out any airway compression before considering endovascular stent implantation. If a PA stent’s compression has already caused severe bronchial obstruction, our balloon-splinted decompression technique should be considered.