Pediatric Cardiology

, Volume 38, Issue 5, pp 1077–1079 | Cite as

Strategies to Prevent Cast Formation in Patients with Plastic Bronchitis Undergoing Heart Transplantation

  • John J. Parent
  • Robert K. Darragh
  • Jeffrey G. Gossett
  • Thomas D. Ryan
  • Chet R. Villa
  • Angela Lorts
  • John L. Jefferies
  • Jeffrey A. Towbin
  • Clifford Chin
Case Report

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.

Keywords

Plastic bronchitis Pediatric heart transplantation Fontan Single ventricle 

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • John J. Parent
    • 1
  • Robert K. Darragh
    • 1
  • Jeffrey G. Gossett
    • 2
  • Thomas D. Ryan
    • 3
  • Chet R. Villa
    • 3
  • Angela Lorts
    • 3
  • John L. Jefferies
    • 3
  • Jeffrey A. Towbin
    • 4
  • Clifford Chin
    • 3
  1. 1.Division of Pediatric Cardiology, Indiana University School of Medicine – Riley HospitalIndiana University HealthIndianapolisUSA
  2. 2.Division of Pediatric CardiologyAnn and Robert H Lurie Children’s Hospital of ChicagoChicagoUSA
  3. 3.The Heart InstituteCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  4. 4.The Heart InstituteLe Bonheur Children’s HospitalMemphisUSA

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