title: Bronchial compression following pulmonary artery stenting in single ventricle lesions: how to prevent, and how to decompress.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Congenital Heart Defects and Paediatric Cardiology, Heart Centre, University of Freiburg, Mathildenstrasse 1, Freiburg im Breisgau, Germany. jochen.grohmann@universitaets-herzzentrum.de.
authors.forename: J
authors.initials: J
authors.lastname: Grohmann
authors.affiliation: Department of Congenital Heart Defects and Paediatric Cardiology, Heart Centre, University of Freiburg, Mathildenstrasse 1, Freiburg im Breisgau, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Stiller
authors.affiliation: Department of Congenital Heart Defects and Paediatric Cardiology, Heart Centre, University of Freiburg, Mathildenstrasse 1, Freiburg im Breisgau, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Neumann
authors.affiliation: Department of Congenital Heart Defects and Paediatric Cardiology, Heart Centre, University of Freiburg, Mathildenstrasse 1, Freiburg im Breisgau, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Jakob
authors.affiliation: Department of Congenital Heart Defects and Paediatric Cardiology, Heart Centre, University of Freiburg, Mathildenstrasse 1, Freiburg im Breisgau, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Fleck
authors.affiliation: Department of Radiology, Section of Cardiovascular Radiology, University of Freiburg, Mathildenstrasse 1, Freiburg im Breisgau, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Pache
authors.affiliation: Department of Cardiovascular Surgery, Heart Centre, University of Freiburg, Mathildenstrasse 1, Freiburg im Breisgau, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Siepe
authors.affiliation: Department of Congenital Heart Defects and Paediatric Cardiology, Heart Centre, University of Freiburg, Mathildenstrasse 1, Freiburg im Breisgau, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Höhn
mesh_terms: D000293:Adolescent; D000328:Adult; D000402:Airway Obstruction / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy; D000800:Angioplasty, Balloon; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D001980:Bronchi; D001999:Bronchoscopy; D006328:Cardiac Catheterization; D002648:Child; D002675:Child, Preschool; D000072226:Computed Tomography Angiography; D003251:Constriction, Pathologic; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation*; D005858:Germany; D006330:Heart Defects, Congenital / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007223:Infant; D010166:Palliative Care; D011237:Predictive Value of Tests; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome; D055815:Young Adult
keywords: Airway compression; Congenital heart disease; Paediatric cardiology; Pulmonary artery stenting; Single ventricle palliation