Transbronchial biopsies in children after heart-lung transplantation.
Sixty transbronchial biopsies have been performed in eight children after heart-lung transplantation. The selection of fiber-optic bronchoscope or a small (4 mm; 30 cm) rigid bronchoscope was made according to the size of endotracheal tube required at surgery. If the endotracheal tube was size 7.5 or greater, a fiber-optic bronchoscope was used, whereas if the endotracheal tube size was below 7, a rigid bronchoscope was used. For the diagnosis of lung rejection, the histology of biopsies revealed a sensitivity of 91% and specificity of 69% (similar to the result in adults). The histology also distinguished lung infection from rejection. Complications included three pneumothoraces and two clinically significant episodes of hemorrhage, one of which led to a cardiorespiratory arrest, which may have been caused by hypoxia. As a result, arterial oxygen saturation is now monitored during the procedure using a pulse oximeter.
Scott
J P
JP
Heart-Lung Transplant Groups, Papworth Hospital, Cambridge, UK.
Higenbottam
T W
TW
Smyth
R L
RL
Whitehead
B
B
Helms
P
P
Fradet
G
G
De Leval
M
M
Wallwork
J
J
D000293:Adolescent; D001706:Biopsy; D001980:Bronchi / Q000473:pathology*; D020680:Bronchoscopes; D001999:Bronchoscopy / Q000009:adverse effects / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D005541:Forced Expiratory Volume; D006084:Graft Rejection; D006323:Heart Arrest / Q000209:etiology; D016041:Heart-Lung Transplantation / Q000276:immunology*; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D015994:Incidence; D008171:Lung Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology*; D008297:Male; D009894:Opportunistic Infections / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology*; D011014:Pneumonia / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology*; D011030:Pneumothorax / Q000209:etiology; D012680:Sensitivity and Specificity; D013997:Time Factors