Left Bronchial Stenosis Research Articles

ATYPICAL VARIANT OF GRANULOMATOSIS WITH POLYANGIITIS WITH EOSINOPHILIA

ATYPICAL VARIANT OF GRANULOMATOSIS WITH POLYANGIITIS WITH EOSINOPHILIA

Right esophageal lung with esophageal atresia and left bronchial stenosis.

Right esophageal lung with esophageal atresia and left bronchial stenosis.

Anesthetic experience of extracorporeal membrane oxygenation-assisted bronchial stenting in a patient with left bronchial stenosis complicated by severe right pulmonary artery stenosis

Anesthetic experience of extracorporeal membrane oxygenation-assisted bronchial stenting in a patient with left bronchial stenosis complicated by severe right pulmonary artery stenosis

The Study of Lophomonas Blattarum Infection in Children with Respiratory Symptoms: A Descriptive Clinical Study in North East of Iran

Background: Lophomonas blattarum is protozoan generally parasitizes in the intestinal tracts of some arthropods. It can infect adults and children with unspecific respiratory symptoms. We aimed to investigate the frequency of Lophomonas blattarum in children with respiratory symptoms in North East of Iran. Materials and Methods: One hundred fifty-six children with respiratory symptoms were investigated in a descriptive-analytical study using Bronchoalveolar lavage (BAL) according to enumeration method in March 2016 to March 2017.Data was collected via a check list, prospectively. All had Bronchoscopy and chest X-ray. The data were analyzed using SPSS program. Results: Of the 156 studied children,40.4% (n=63) of patients with the average age of 5.11±2.9 years were positive for L. blattarum infection. In positive cases, 42.9% (n=27) were male. There was a significant relationship between gender and Lophomonas infection (p=0.0006). The most common respiratory symptoms were cough, fever, wheeze and tachypnea. Radiography of infected patients showed pulmonary infiltration (16.7%), unilateral lung hyperinflation (23.1%), consolidation (19.9%), and lung collapse (14.7%). Underlying diseases were detected in 4 infected patients. Bronchoscopy showed abnormal results in 22 patients (14.1%). Most common abnormalities were in order: mucus plaque (22.7%), left bronchomalacia (18.2%), left bronchial stenosis (18.2%) and foreign body aspiration (13.6%). Conclusion: Generally, 40.4% of children with respiratory symptoms were positive for L. blattarum infection. It is suggested to consider L. blattarum as a cause of pulmonary infections in patients with pulmonary symptoms.

Tailored Y-stent on the Secondary Carina for Recurrent Nonanastomotic Posttransplant Left Bronchial Stenosis.

Tailored Y-stent on the Secondary Carina for Recurrent Nonanastomotic Posttransplant Left Bronchial Stenosis.

A Case Report Describing General Anesthesia for Wisdom Tooth Extraction Performed in an Intellectually Disabled Patient with Congenital Right Pulmonary Agenesis and Left Bronchial Stenosis

A Case Report Describing General Anesthesia for Wisdom Tooth Extraction Performed in an Intellectually Disabled Patient with Congenital Right Pulmonary Agenesis and Left Bronchial Stenosis

Post-Cardiac Surgery Localized Alveolar Hemorrhage: A Diagnostic Challenge

SESSION TITLE: Fellow Case Report Poster - Cardiac and Transplant Surgery SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM INTRODUCTION: Alveolar hemorrhage is associated with syndromes causing capillaritis, diffuse alveolar damage or bland pulmonary hemorrhage. We present a case of localized alveolar hemorrhage following cardiac surgery. CASE PRESENTATION: A 23-year old woman with a history of primum type atrial septal defect repair and mitral cleft closure presents as an adult with left bronchial stenosis associated with a vascular ring and RVOT obstruction. She underwent ductus arteriosus ligation, RVOT augmentation and stenting of left bronchus. She returned with severe mitral regurgitation associated with hemoptysis and chest pain. She underwent mitral valve repair and uproofing of the coronary sinus which had been previously baffled to the left atrium during repair of her primum ASD. Post operatively, she had persistent hypoxemia and hemoptysis. Chest X-ray and non-contrast computerized CT scan revealed infiltrates worse on the right. Bronchoscopy with serial lavages showed bloody fluid consistent with alveolar hemorrhage. A trans esophageal echocardiogram was technically difficult but appeared to show patent right sided pulmonary veins. However, subsequent CT scan with contrast demonstrated no flow in the right-sided pulmonary veins. Urgent repeat surgery revealed a single, right-sided pulmonary vein orifice with possible narrowing near the left atriotomy. We removed extensive clot within the pulmonary venous system and reconstructed the junction between the pulmonary vein and left atrium. During this time she developed thrombocytopenia suggesting the possibility of heparin induced thrombocytopenia and thrombosis. However the serotonin release assay was negative. DISCUSSION: Alveolar hemorrhage is an infrequently reported complication following cardiac surgery. It is usually diffuse and considered to be the result of inflammation or drug reaction. This patient presented with localized alveolar hemorrhage secondary to unilateral pulmonary venous thrombosis. The etiology of her clot development was likely mechanical from low flow through a narrowed orifice. The process improved following surgical clot removal and post-operative anticoagulation. CONCLUSIONS: The differential diagnosis of alveolar hemorrhage in patients who have recently undergone cardiac surgery should include pulmonary venous thrombosis, particularly when hemorrhage is localized Reference #1: A case of diffuse alveolar hemorrhage developing after open heart surgery. Nakamura Y, Shimokawa S, Watanabe S, Sakasegawa K, Sakata R, Higashi M, Miyahara K. Kyobu Geka. 2001;54:892-4 DISCLOSURE: The following authors have nothing to disclose: Yashaswini Yeragunta, Luke Wiggins, Kriti Lonial, David Kelley, Craig Baker No Product/Research Disclosure Information

The Concept of the Arch Window in the Spiral Switch of the Great Arteries.

When the arterial switch operation includes the Lecompte maneuver, the arterial trunks are reconnected in parallel, rather than the spiral fashion observed in the normal heart. Thus, although the ventriculo-arterial connections are hemodynamically corrected, the anatomic arrangement cannot be considered normal. We hypothesized that, if feasible, it would be advantageous to restore a spiral configuration for the arterial trunks. In 58 patients, we reconstructed the arterial trunks such that, postoperatively, the pulmonary channel spirals round the aorta, passing to either the right or the left, and branches posteriorly. We compared the outcomes with those in 95 patients undergoing a standard non-spiraling operation over the same period. Average follow-up was 8.2±4.5years. The estimated 10-year survival was similar in the cohorts, at 94.7% for those with spiraling trunks, as compared to 90.4% for those with parallel outflow tracts. Reoperation-free survival at 10years was not significantly different (87.6 vs. 90.5%). Supravalvar pulmonary stenosis, aortic neo-coarctation, or left bronchial stenosis, however, was encountered in one-eighth of those undergoing a standard operation. None of these complications occurred in those patients who, postoperatively, had spiraling outflow tracts (P=0.002). Reconstruction of spiraling trunks after the arterial switch has, thus far, avoided the complications of supravalvar pulmonary stenosis, neo-aortic kinking, or bronchial stenosis. The spiraling arrangement prevents compression of the pulmonary vessels and bronchial tree by the aorta, since it provides a wide window in the new aortic arch.

Three-dimensional rotational angiography in the assessment of vascular and airway compression in children after a cavopulmonary anastomosis.

The aim of the study was to examine the role of three-dimensional rotational angiography (3DRA) in assessing vascular and airway narrowing in children with a bidirectional cavopulmonary anastomosis (BCPA). The course of children with single ventricle physiology is often complicated by left pulmonary artery (LPA) and/or bronchial stenosis and may be related to aortic compression. 3DRA may be useful in evaluating this complex anatomy and possible mechanisms for the observed obstruction. Clinical data and imaging (2D angiography and 3DRA) of children with a BCPA were reviewed retrospectively. Measurements were taken at similar locations along the pulmonary arteries in both modalities and in the airways on 3DRA. Twenty-five children with a previous BCPA were assessed at mean age of 3.1 ± 2.0 years and weight of 13.6 ± 3.6 kg. Excellent correlation was found between 3DRA and 2D angiographic LPA measurements (r = 0.89, p < 0.0001). Twelve children had qualitative LPA stenosis on 3DRA, with a stenotic dimension of 6.6 ± 2.2 mm on 2D angiography and 6.8 ± 1.9 mm on 3DRA (r = 0.94, p < 0.0001). Ten cases with LPA stenosis also had bronchial stenosis (83 %). Qualitative airway assessment correlated with quantitative bronchial dimensions from 3DRA-derived tomographic images: Bronchial stenosis measured 4.4 ± 1.6 versus 5.9 ± 1.1 mm in those with a normal appearing bronchus (p = 0.009). Hybrid patients (initial palliation with bilateral pulmonary artery banding and arterial ductal stenting, n = 5) and all patients with a Damus-Kaye-Stansel (DKS) anastomosis (n = 9) were more likely to have LPA and left bronchial stenosis (OR 7.7, p = 0.04). 3DRA is a useful and accurate tool in assessment of LPA and airway narrowing after BCPA. Hybrid and DKS patients are more prone to LPA and bronchial stenosis, and 3DRA can provide insight into the mechanism.

Clinical outcomes of slide tracheoplasty in congenital tracheal stenosis.

Treatment of long-segment congenital tracheal stenosis (CTS) remains challenging. Recently, slide tracheoplasty has become the standard approach in many centres. The aim of this study was to evaluate the clinical outcomes of slide tracheoplasty. Between 2004 and 2011, 18 patients underwent slide tracheoplasty in our centre. The median patient age was 2.5 months (range, 18 days-4 years) and the median body weight was 4.2 (range, 2.2-17.7) kg at operation. Eleven (61%) patients were on a mechanical ventilator prior to surgery. The median stenotic segment estimated by a computed tomography scan was 52% of the length of total trachea (range, 18-84%). Five (28%) patients had proximal bronchial stenosis, 3 (17%) had tracheal bronchus, 2 (11%) had tracheobronchomalacia and 1 (6%) had agenesis of the right lung. Thirteen (72%) patients had a combined cardiac anomaly, including 8 patients with a pulmonary artery sling. Ten (56%) patients had associated extracardiac anomalies. Slide tracheoplasty was performed on cardiopulmonary bypass in all patients, and cardiac lesions were corrected. There was no early death. The patient with agenesis of the right lung died of left bronchial stenosis 3 months after the surgery. Two (11%) patients were reoperated on for tracheal restenosis. In the other 15 patients, the median duration of ventilator support was 8 (range, 5-34) days and the median duration of hospitalization was 31 (range, 12-79) days. During the follow-up (median duration of 17 months; range, 2-77 months), 13 (72%) patients were symptom-free and 2 (11%) underwent tracheostomy for tracheomalacia. Based on this study, slide tracheoplasty seems to be an effective technique for CTS. However, shortening of the trachea after reconstruction may give rise to recurrent obstruction.

Fontan completion after external stenting of the left bronchus and intrapulmonary artery septation for left pulmonary artery hypoplasia

Tracheobronchial obstruction and unilateral hypoplasia of the pulmonary artery are serious barriers to successful Fontan completion. We describe a 5-year old girl with left bronchial obstruction, hypoplasia of the left pulmonary artery and a single ventricle (double inlet left ventricle). She had undergone external stenting to treat left bronchial stenosis at 3 years of age, bidirectional cavopulmonary anastomosis and Damus-Kaye-Stansel anastomosis at 4 years of age, intrapulmonary artery septation 1 year later and, finally, completion of the Fontan operation with excellent postoperative haemodynamics.

Protein losing enteropathy secondary to a pulmonary artery stent

A 2-year-old patient with hypoplastic left heart syndrome presented 6 months following Fontan completion with protein-losing enteropathy (PLE). He had undergone stent implantation in the left pulmonary artery after the Norwood procedure, followed by redilation of the stent prior to Fontan completion. Combined bronchoscopic and catheterization studies during spontaneous breathing confirmed left bronchial stenosis behind the stent, and diastolic systemic ventricular pressure during expiration of 25 mm Hg. We postulate that the stent acts as a valve, against which the patient generates high expiratory pressures, which are reflected in the ventricular diastolic pressure. This may be the cause of PLE.

Mucous Membrane Pemphigoid With Fatal Bronchial Involvement in a Seventeen-Year-Old Girl

This study was designed to report a case of biopsy-proven mucous membrane pemphigoid with severe bronchial involvement in a young woman. Case report of a 17-year-old girl who presented with worsening dyspnea, skin rash, and bilateral ocular injection, symblepharon, and fornix foreshortening. Conjunctival, skin, and bronchial biopsies were performed along with imaging and serological tests in an effort to establish a diagnosis for this unusual constellation of findings. The surprising occurrence of a cerebrovascular accident during her hospitalization also prompted a search for a concurrent coagulation disorder. Immunofluorescence studies of conjunctival, skin, and bronchial tissue specimens revealed deposition of multiple antibody classes at the basement membrane zone. The patient also possessed circulating basement membrane zone antibodies in her serum and a significant titer of antiphospholipid antibodies. She underwent dilation and stent placement for subglottic tracheal and left bronchial stenosis and was treated with immunosuppressive agents. After a favorable initial response, the patient experienced progressive bronchial stenosis and respiratory compromise, culminating in her death from bronchospasm and cardiopulmonary arrest. To our knowledge, this is the first report of mucous membrane pemphigoid involving the lower airways that was confirmed by immunofluorescence analysis. It highlights the potentially lethal, systemic nature of mucous membrane pemphigoid and underscores the need to question patients about symptoms of respiratory dysfunction.

A case of stenosis of the bronchus caused by invasion of the recurrent esophageal cancer which was treated by endoscopic microwave tissue coagulation and expandable metallic stents

A self-expandable metallic stent, Gianturco-Rösch Z-stent (Cook), was used to the patient of the left bronchial stenosis due to recurrent esophageal cancer. The stent was inserted easily with fiberoptic bronchoscopy under local anesthesia, following immediate improvement of atelectasis of the left lung. After 10 days, it became again obstructed because the tumor grew up through the spaces between the wires. The tumor was easily cauterised and removed by endoscopic tissue coagulation. Thereafter another stent was inserted within the initial stent (stent in stent) to prevent more ingrowth of the tumor. The patency of the airway continued for a few months until the patient deceased from worsening of the general condition.