title: Intra-procedural Bronchoscopy to Prevent Bronchial Compression During Pulmonary Artery Stent Angioplasty.
abstract: 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 mainstem bronchus. Following such a case, we re-evaluated our approach to PA stent angioplasty in these patients. 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 January 1, 2005 and January 5, 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. Sixty-five 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 one subject had moderate bronchial compression. To date, seven 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. 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.
authors.affiliation: Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 34th St and Civic Center Blvd, Philadelphia, PA, 19147, USA. mlobyrne@childrensnational.org.
authors.forename: Michael L
authors.initials: ML
authors.lastname: O'Byrne
authors.affiliation: Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 34th St and Civic Center Blvd, Philadelphia, PA, 19147, USA.
authors.forename: Nita
authors.initials: N
authors.lastname: Rome
authors.affiliation: Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 34th St and Civic Center Blvd, Philadelphia, PA, 19147, USA.
authors.forename: Ramiro W Lizano
authors.initials: RW
authors.lastname: Santamaria
authors.affiliation: Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 34th St and Civic Center Blvd, Philadelphia, PA, 19147, USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Hallbergson
authors.affiliation: Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 34th St and Civic Center Blvd, Philadelphia, PA, 19147, USA.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Glatz
authors.affiliation: Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 34th St and Civic Center Blvd, Philadelphia, PA, 19147, USA.
authors.forename: Yoav
authors.initials: Y
authors.lastname: Dori
authors.affiliation: Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 34th St and Civic Center Blvd, Philadelphia, PA, 19147, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Gillespie
authors.affiliation: Division of Pulmonology, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19147, USA.
authors.forename: Samuel
authors.initials: S
authors.lastname: Goldfarb
authors.affiliation: Pulmonary, Allergy, and Critical Care Division, Section of Interventional Pulmonary and Thoracic Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19147, USA.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Haas
authors.affiliation: Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 34th St and Civic Center Blvd, Philadelphia, PA, 19147, USA.
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Rome
mesh_terms: D000293:Adolescent; D000328:Adult; D058109:Airway Management / Q000379:methods*; D017130:Angioplasty / Q000009:adverse effects*; D001999:Bronchoscopy / Q000379:methods*; D006328:Cardiac Catheterization / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003251:Constriction, Pathologic / Q000601:surgery; D005260:Female; D018729:Fontan Procedure / Q000009:adverse effects; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000150:complications* / Q000601:surgery; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D011651:Pulmonary Artery / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: Airway; Bronchus; Cardiac catheterization; Fontan; Stents