Tuesday, April 14, 2015

Single Lumen Tube As Endobronchialstent To Manage Left Bronchial Compression Post Total Anomalous Pulmonary Venous Connection Repair

Case History:

A 6-month-old female child presented to emergency department with respiratorydistress. On examination, the child was found to have tachycardia, tachypnea, subcostalretractions and peripheral oxygen saturation of 85% on oxygen (5 l/min) with no fever. On transthoracic echocardiography, a diagnosis of obstructed supracardiac total anomalous pulmonary venous connection (TAPVC) with atrial septal defect (ASD) and severe pulmonary artery hypertension was made. The child was managed for congestive heart failure and intubated and mechanically ventilated. On preoperative chest X-ray, a homogenous opacity was seen on the left side [Figure 1]. Therefore, endotracheal (ET) secretions were sent for culture, and empirical antibiotic therapy was started. On 3rdday Acinetobacterspp. was reported in the ET secretions and the child was treated with antibiotics for 5 days before being taken for surgery. A TAPVC repair was done by anastomosing the common chamber with the left atrium, ligating the vertical vein and closing the ASD. The child was stable in the immediate postoperative period with stable hemodynamics and arterial blood gases.

POINTS TO PONDER

  • Bronchial stenosis should be considered in difficult to wean children with congenital heart disease.
  • Is short term stenting is useful in relieving bronchial stenosis after congenital heart surgeries?
  • Bronchial Stenosis can be repaired in a single setting with congenital heart surgery, with appropriate planning.
  • What is most appropriate line of management if tracheobronchial stenosis is diagnosed preoperatively? Can both stenting and corrective cardiac surgery be done in same setting?

 

Read Full Article at:  http://www.annals.in/article.asp?issn=0971-9784;year=2015;volume=18;issue=2;spage=217;epage=220;aulast=Singh

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