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

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.