The Lecompte Maneuver as an Alternative to Reduction Pulmonary Arterioplasty for Relief of Airway Compression in Absent Pulmonary Valve Syndrome

Abstract

We read with great interest the article by Nölke and colleagues 1Nölke L. Azakie A. Anagnostopulos P.V. Alphonso N. Karl T.R. The Lecompte maneuver for relief of airway compression in absent pulmonary valve syndrome.Ann Thorac Surg. 2006; 81: 1802-1807Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar] describing the benefits of the Lecompte maneuver for relief of airway compression in absent pulmonary valve syndrome.Interestingly we have recently performed the same procedure in 2 patients aged 6 and 10 months, with absent pulmonary valve syndrome and with aneurysmal dilatation of the pulmonary arteries. Obstructive respiratory symptoms with wheezing and compression of the bronchial tree by the aneurysmal pulmonary arteries had been well documented on a preoperative bronchoscopy. Pulsatile compression was more pronounced on the side where the aneurysmal pulmonary artery was in relation with the aortic arch. The chest computed tomographic scan had shown some degree of emphysema in the area where the bronchial obstruction was more pronounced. Surgical repair consisted of interventricular septal defect closure by a pericardial patch and anastomosis of a Contegra (Medtronic Inc, Minneapolis, MN) pulmonary valved conduit (Medtronic Inc) between the right ventricle and the pulmonary bifurcation, but without reduction pulmonary arterioplasty. The aim of the Lecompte maneuver was to reduce the diameter of the pulmonary arteries by a stretching mechanism. It was achieved by transverse section of the ascending aorta and dissection of the pulmonary arteries, mobilizing and placing the pulmonary bifurcation in an anterior position to the aorta. The immediate postoperative bronchoscopy showed persistent but significantly decreased compression of the bronchial tree. The 2 patients were rapidly extubated without respiratory symptoms. The clinical outcome was excellent without any residual obstructive respiratory symptoms.The Lecompte maneuver has already been described to relieve airway compression in other cardiopathies, in case reports of truncus arteriosus [2Haydar S. Lecompte maneuver in truncus arteriosus repair: potential risks!.Ann Thorac Surg. 1996; 62: 1241Abstract Full Text PDF PubMed Scopus (6) Google Scholar, 3Cohen D.M. Lecompte maneuver for truncus arteriosus with type B arch interruption: is this a panacea?.Ann Thorac Surg. 1995; 60: 229Abstract Full Text PDF PubMed Scopus (7) Google Scholar] or tetralogy of Fallot with an absent pulmonary valve [4Hraska V. A new approach to correction of tetralogy of Fallot with absent pulmonary valve.Ann Thor Surg. 2000; 69: 1601-1602Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar, 5Hraska V. Kantorova A. Kunovsky P. Haviar D. Intermediate results with correction of tetralogy of Fallot with absent pulmonary valve using a new approach.Eur J Cardiothor Surg. 2002; 21: 711-714Crossref PubMed Scopus (23) Google Scholar], with controversial results that may vary on the type of tracheobronchial compression. In our two cases, surgical repair of absent pulmonary valve syndrome and aneurysmal dilatation of the pulmonary arteries, including a Lecompte maneuver was an alternative to reduction pulmonary arterioplasty, since the Lecompte maneuver alone had a good impact on relief of airway compression. This was well documented by comparing the preoperative and postoperative bronchoscopies that were performed nearly in the same ventilatory conditions. By changing the mediastinal geometry and the relationship between the great vessels and the bronchial tree, together with a stretching mechanism of the pulmonary arteries, thus allowing a reduction in their diameter, the Lecompte maneuver had a favorable impact on the respiratory tract compressions. In this scenario, the eventual need for further reduction pulmonary arterioplasty may be evaluated with a perioperative bronchoscopy. We read with great interest the article by Nölke and colleagues 1Nölke L. Azakie A. Anagnostopulos P.V. Alphonso N. Karl T.R. The Lecompte maneuver for relief of airway compression in absent pulmonary valve syndrome.Ann Thorac Surg. 2006; 81: 1802-1807Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar] describing the benefits of the Lecompte maneuver for relief of airway compression in absent pulmonary valve syndrome. Interestingly we have recently performed the same procedure in 2 patients aged 6 and 10 months, with absent pulmonary valve syndrome and with aneurysmal dilatation of the pulmonary arteries. Obstructive respiratory symptoms with wheezing and compression of the bronchial tree by the aneurysmal pulmonary arteries had been well documented on a preoperative bronchoscopy. Pulsatile compression was more pronounced on the side where the aneurysmal pulmonary artery was in relation with the aortic arch. The chest computed tomographic scan had shown some degree of emphysema in the area where the bronchial obstruction was more pronounced. Surgical repair consisted of interventricular septal defect closure by a pericardial patch and anastomosis of a Contegra (Medtronic Inc, Minneapolis, MN) pulmonary valved conduit (Medtronic Inc) between the right ventricle and the pulmonary bifurcation, but without reduction pulmonary arterioplasty. The aim of the Lecompte maneuver was to reduce the diameter of the pulmonary arteries by a stretching mechanism. It was achieved by transverse section of the ascending aorta and dissection of the pulmonary arteries, mobilizing and placing the pulmonary bifurcation in an anterior position to the aorta. The immediate postoperative bronchoscopy showed persistent but significantly decreased compression of the bronchial tree. The 2 patients were rapidly extubated without respiratory symptoms. The clinical outcome was excellent without any residual obstructive respiratory symptoms. The Lecompte maneuver has already been described to relieve airway compression in other cardiopathies, in case reports of truncus arteriosus [2Haydar S. Lecompte maneuver in truncus arteriosus repair: potential risks!.Ann Thorac Surg. 1996; 62: 1241Abstract Full Text PDF PubMed Scopus (6) Google Scholar, 3Cohen D.M. Lecompte maneuver for truncus arteriosus with type B arch interruption: is this a panacea?.Ann Thorac Surg. 1995; 60: 229Abstract Full Text PDF PubMed Scopus (7) Google Scholar] or tetralogy of Fallot with an absent pulmonary valve [4Hraska V. A new approach to correction of tetralogy of Fallot with absent pulmonary valve.Ann Thor Surg. 2000; 69: 1601-1602Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar, 5Hraska V. Kantorova A. Kunovsky P. Haviar D. Intermediate results with correction of tetralogy of Fallot with absent pulmonary valve using a new approach.Eur J Cardiothor Surg. 2002; 21: 711-714Crossref PubMed Scopus (23) Google Scholar], with controversial results that may vary on the type of tracheobronchial compression. In our two cases, surgical repair of absent pulmonary valve syndrome and aneurysmal dilatation of the pulmonary arteries, including a Lecompte maneuver was an alternative to reduction pulmonary arterioplasty, since the Lecompte maneuver alone had a good impact on relief of airway compression. This was well documented by comparing the preoperative and postoperative bronchoscopies that were performed nearly in the same ventilatory conditions. By changing the mediastinal geometry and the relationship between the great vessels and the bronchial tree, together with a stretching mechanism of the pulmonary arteries, thus allowing a reduction in their diameter, the Lecompte maneuver had a favorable impact on the respiratory tract compressions. In this scenario, the eventual need for further reduction pulmonary arterioplasty may be evaluated with a perioperative bronchoscopy. ReplyThe Annals of Thoracic SurgeryVol. 83Issue 2PreviewIt is with interest that we read Tissot and colleagues’ 1] letter. They have re-stated the value of the Lecompte maneuver in congenital cardiac conditions associated with hypertensive dilatation of the pulmonary arteries resulting in bronchial compression; in our article we included such a patient with totally anomalous pulmonary venous drainage (APVS). Currently we selectively use reduction arterioplasty, and we certainly have seen cases in which a good result was achieved using the Lecompte maneuver in isolation. Full-Text PDF