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- Title
Strategies to Prevent Cast Formation in Patients with Plastic Bronchitis Undergoing Heart Transplantation.
- Authors
Parent, John; Darragh, Robert; Gossett, Jeffrey; Ryan, Thomas; Villa, Chet; Lorts, Angela; Jefferies, John; Towbin, Jeffrey; Chin, Clifford
- Abstract
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.
- Subjects
HEART transplantation; PEDIATRICS; PLASMINOGEN activators; PALLIATIVE treatment; BRONCHOSCOPY
- Publication
Pediatric Cardiology, 2017, Vol 38, Issue 5, p1077
- ISSN
0172-0643
- Publication type
Report
- DOI
10.1007/s00246-017-1568-y