Abstract | BACKGROUND: METHODS: This was a retrospective case series of medical, surgical, and catheter-based treatment of patients with plastic bronchitis after cavopulmonary palliation. RESULTS: Included were 14 patients (86% male, 93% white). Median age at Fontan operation was 2.7 years (range, 1.2 to 4.1 years), with median interval to plastic bronchitis presentation of 1.5 years (range, 9 days to 15.4 years). Cast composition was available for 11 patients (79%) and included fibrin deposits in 7. All patients were treated with pulmonary vasodilators, and 13 (93%) were treated with inhaled t-PA. Hemodynamically significant lesions in the Fontan pathway were addressed by catheter-based (n=9) and surgical (n=3) interventions. Three patients (21%) underwent heart transplantation. Median follow-up was 2.7 years (range, 0.6 to 8.7 years). Symptoms improved, such that 6 of 13 patients (46%) were weaned off t-PA. Rare or episodic casts are successfully managed with outpatient t-PA in most of the other patients. Of the 3 patients who underwent heart transplant, 2 are asymptomatic and 1 has recurrent casts in the setting of elevated filling pressures and rejection. CONCLUSIONS: A systematic step-wise algorithm that includes optimization of hemodynamics, aggressive pulmonary vasodilation, and inhaled t-PA is an effective treatment strategy for patients with plastic bronchitis after cavopulmonary connection.
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Authors | Catherine M Avitabile, David J Goldberg, Kathryn Dodds, Yoav Dori, Chitra Ravishankar, Jack Rychik |
Journal | The Annals of thoracic surgery
(Ann Thorac Surg)
Vol. 98
Issue 2
Pg. 634-40
(Aug 2014)
ISSN: 1552-6259 [Electronic] Netherlands |
PMID | 24841545
(Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
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Copyright | Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved. |
Topics |
- Bronchitis
(etiology, therapy)
- Child, Preschool
- Combined Modality Therapy
- Female
- Fontan Procedure
(adverse effects)
- Humans
- Infant
- Male
- Palliative Care
- Retrospective Studies
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