Strategies to Prevent Cast Formation in Patients with Plastic Bronchitis Undergoing Heart Transplantation
| Autor: | Robert K. Darragh, Clifford Chin, John J. Parent, Thomas J. Ryan, Angela Lorts, Chet R. Villa, Jeffrey A. Towbin, Jeffrey G. Gossett, John L. Jefferies |
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| Rok vydání: | 2017 |
| Předmět: |
Heart Defects
Congenital Male medicine.medical_specialty medicine.medical_treatment Population 030204 cardiovascular system & hematology Fontan Procedure 03 medical and health sciences 0302 clinical medicine Fibrinolytic Agents Bronchoscopy Administration Inhalation Humans Medicine Bronchitis Child education Mechanical ventilation Heart transplantation education.field_of_study medicine.diagnostic_test business.industry Vascular surgery Surgery Cardiac surgery Airway Obstruction Transplantation 030228 respiratory system Tissue Plasminogen Activator Pediatrics Perinatology and Child Health Heart Transplantation Female Cardiology and Cardiovascular Medicine business Complication |
| Zdroj: | Pediatric Cardiology. 38:1077-1079 |
| ISSN: | 1432-1971 0172-0643 |
| DOI: | 10.1007/s00246-017-1568-y |
| Popis: | Plastic bronchitis, a rare complication after Fontan palliation, carries a high morbidity and mortality risk. Heart transplantation is an effective treatment option, but casts may occur in the early post-operative period. We present a case series detailing peri-operative management strategies to minimize morbidity and mortality related to plastic bronchitis in patients undergoing heart transplantation. Patient 1 received no treatment pre-, intra-, or post-transplant for prevention of bronchial casts and developed severe respiratory acidosis 18 h following transplant. Emergent bronchoscopy was performed and a large obstructive cast was removed. The patient recovered and received inhaled tissue plasminogen activator (tPA) for 5 days. Patient 2 received inhaled tPA before, during, and for 5 days after transplantation and no bronchial casts developed. Patient 3 underwent intraoperative bronchoscopy just prior to implantation revealing no casts. The patient underwent non-urgent, preemptive bronchoscopy on post-transplant days 1, 3, and 4, removing several partially obstructive bronchial blood clots/casts, with no casts thereafter. Heart transplantation results in eventual resolution of plastic bronchitis. Residual bronchial casts can still be problematic in the peri-operative period. Airway clearance with inhaled tPA or bronchoscopy may prevent the need for prolonged mechanical ventilation and reduce post-operative morbidity in this unique population. |
| Databáze: | OpenAIRE |
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