Thorac Cardiovasc Surg 2016; 64 - OP155
DOI: 10.1055/s-0036-1571883

Bronchial Compression by Mass Effect following Pulmonary Artery Stenting: Its Prevention and Decompression

J. Grohmann 1, B. Stiller 1, E. Neumann 1, A. Jakob 1, K. Reineker 1, T. Fleck 1, G. Pache 2, M. Siepe 3, J. Kroll 3, R. Höhn 1
  • 1Heart Center, University of Freiburg, Department of Congenital Heart Defects and Pediatric Cardiology, Freiburg, Germany
  • 2University of Freiburg, Department of Radiology, Section of Cardiovascular Radiology, Freiburg, Germany
  • 3Heart Center, University of Freiburg, Department of Cardiovascular Surgery, Freiburg, Germany

Objectives: To assess bronchial compression during pulmonary artery (PA) intervention in single ventricle (SV) lesions with a prominent neo-aortic root.

Methods: Single-center retrospective analysis of 19 SV patients with branch PA stenosis and close proximity to the ipsilateral main bronchus who underwent cardiac catheterization 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 from an almost-closed left-main bronchus (LMB) following PA stenting. Fortunately, LMB decompression succeeded in both affected patients by re-shaping the PA-stents via chest compressions while splinting the LMB with an inflated balloon. Thus, to prevent the other 17 patients from this serious complication, we shifted to a thorough preparation strategy: in 13 patients consistent impact assessment was safely performed by simultaneous bronchoscopy and cardiac catheterization. In the remaining 4 patients CT-angiography permitted a proper risk evaluation prior to recatheterization.

Conclusion: In SV lesions accompanied by branch PA stenosis, thorough preparation via cross-sectional imaging is mandatory, including test-ballooning, 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.