Strategies to Prevent Cast Formation in Patients with Plastic Bronchitis Undergoing Heart Transplantation
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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.
KeywordsPlastic bronchitis Pediatric heart transplantation Fontan Single ventricle
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Conflict of interest
The authors declare that they have no conflict of interest.
- 8.LaRue M, Gossett JG, Stewart RD, Backer CL, Mavroudis C, Jacobs ML (2012) Plastic bronchitis in patients with fontan physiology: review of the literature and preliminary experience with fontan conversion and cardiac transplantation. World J Pediatr Congenit Heart Surg 1:3(3): 364–72.Google Scholar
- 9.Gossett JG, Almond CS, Kirk R, Zangwill S, Richmond ME, Kantor PF, Tresler MA, Lenderman SM, Naftel DC, Matthews KL, Pahl E (2013) Outcomes of cardiac transplantation in single ventricle patients with plastic bronchitis: a multicenter study. J Am Coll Cardiol 61(9):985–986.CrossRefPubMedGoogle Scholar