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Leivaditis V, Braun-Lambur H, Windmüller V, Papatriantafyllou A, Huwe C, Lang D, Grapatsas K, Koletsis EN, Mulita F, Dahm M. Bronchopleural Fistula Management With an Amplatzer Duct Occluder: A Comprehensive Case Report and Literature Review. Cureus 2023; 15:e49431. [PMID: 38149159 PMCID: PMC10750560 DOI: 10.7759/cureus.49431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2023] [Indexed: 12/28/2023] Open
Abstract
Bronchial stump insufficiency (BSI), also reported as bronchopleural fistula, following pneumonectomy is a rare but potentially devastating complication that can result in substantial morbidity and mortality. Despite advances in thoracic surgical techniques and perioperative care, bronchial stump dehiscence remains a challenging clinical scenario, especially when associated with severe infections and compromised patient conditions. Traditional surgical re-intervention to address this complication may carry significant risks and might be contraindicated in certain patients. As a result, innovative interventions are necessary to address these challenging cases effectively. In this report, we present an interventional endoscopic technique using an Amplatzer Duct occluder for the successful management of BSI in a 55-year-old male patient with a complex medical history.
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Affiliation(s)
- Vasileios Leivaditis
- Department of Cardiothoracic and Vascular Surgery, Westpfalz-Klinikum, Kaiserslautern, DEU
| | | | | | | | - Carmen Huwe
- Department of Pneumonology, Westpfalz-Klinikum, Kaiserslautern, DEU
| | - David Lang
- Department of Pneumonology, Westpfalz-Klinikum, Kaiserslautern, DEU
| | - Konstantinos Grapatsas
- Department of Thoracic Surgery and Thoracic Endoscopy, University Medicine Essen - Ruhrlandklinik, Essen, DEU
| | - Efstratios N Koletsis
- Department of Cardiothoracic Surgery, General University Hospital of Patras, Patras, GRC
| | - Francesk Mulita
- Department of Surgery, General University Hospital of Patras, Patras, GRC
| | - Manfred Dahm
- Department of Cardiothoracic and Vascular Surgery, Westpfalz-Klinikum, Kaiserslautern, DEU
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2
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Bai Y, Li Y, Chi J, Guo S. Endobronchial closure of the bronchopleural fistula with the ventricular septal defect occluder: a case series. BMC Pulm Med 2021; 21:313. [PMID: 34620149 PMCID: PMC8496023 DOI: 10.1186/s12890-021-01676-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/20/2021] [Indexed: 11/10/2022] Open
Abstract
Objectives The ventricular septal defect (VSD) occluder has been reported to be a novel method for the closure of bronchopleural fistula (BPF). Our study was to confirm the use of VSD occluder in treating BPF after pneumonectomy or lobectomy. Methods
We performed a single-center, retrospective study of 10 consecutive patients (8 men and 2 women aged 29–70 years) with postoperative BPF receiving the VSD occluder treatment. We used the HeartR™ Membranous VSD occluder (Lifetech Scientific Co., Shenzhen, China) for the closure of BPF through flexible bronchoscopy under general anesthesia. Demographic characteristics, BPF characteristics, and clinical outcomes were collected from patients’ files using the standardized data abstraction forms. Results The underlying diseases were lung cancer in 6 patients, pulmonary tuberculosis in 3, and bronchiectasis in 1. Right-sided BPFs occurred in 6 patients, and left-sided BPFs occurred in 4. Five patients were underweight with a body mass index < 18.5 kg/m2. The VSD was placed in all 10 patients with a 100% technical success rate and a 70% complete closure rate during follow-up with no complications, on a median follow-up period of 115 days (range 46–975 days). In 1 patient, the VSD occluder was reinstalled with complete closure; in 1 and 2 patients with underweight and chronic empyema, the VSD occluders partially and completely failed with good physical tolerance, respectively. Conclusions Our study demonstrated the bronchoscopic closure of BPF after lung resection using the VSD occluder is an off-label but safe and effective method. We prefer to stabilize the BPF by eradicating the underlying diseases and providing nutritional support to those receiving VSD occluder closure treatment.
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Affiliation(s)
- Yang Bai
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, PR China
| | - Yishi Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, PR China
| | - Jing Chi
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, PR China
| | - Shuliang Guo
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, PR China.
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Zhang J, Hu H, Xu L, Xu S, Zhu J, Wu F, Chen E. Innovative method for Amplatzer device implantation in patients with bronchopleural fistulas. BMC Pulm Med 2021; 21:137. [PMID: 33902515 PMCID: PMC8077945 DOI: 10.1186/s12890-021-01493-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 04/11/2021] [Indexed: 11/17/2022] Open
Abstract
Background Bronchopleural fistula (BPF) is a relatively rare complication after various types of pulmonary resection. The double-sided mushroom-shaped occluder (Amplatzer device, AD) has been gradually used for BPF blocking due to its reliable blocking effect. We have improved the existing AD implantation methods to facilitate clinical use and named the new approach Sheath-free method (SFM). The aim of the present report was to explore the reliability and advantages of the SFM in AD implantation. Methods We improved the existing implantation methods by abandoning the sheath of the AD and using the working channel of the bronchoscope to directly store or release the AD without general anesthesia, rigid bronchoscopy, fluoroscopy, or bronchography. A total of 6 patients (5 men and 1 woman, aged 66.67 ± 6.19 years [mean ± SD]) had BPF blocking and underwent the SFM in AD implantation. Results AD implantation was successfully performed in all 6 patients with the SFM, 4 persons had a successful closure of the fistula, one person died after few days and one person did not have a successful closure of the fistula. The average duration of operation was 16.17 min (16.17 ± 4.67 min [mean ± SD]). No patients died due to operation complications or BPF recurrence. The average follow-up time was 13.2 months (range 10–17 months). Conclusion We observed that the SFM for AD implantation—with accurate device positioning and a clear field of vision—is efficient and convenient. The AD is effective in BPF blocking, and could contribute to significantly improved symptoms of patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-021-01493-8.
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Affiliation(s)
- Jisong Zhang
- Department of Pulmonary and Critical Care Medicine, Sir Run Run Shaw Hospital of Zhejiang University, No. 3 East Qingchun Road, Jianggan District, Hangzhou, 310016, Zhejiang Province, China
| | - Huihui Hu
- Department of Pulmonary and Critical Care Medicine, Sir Run Run Shaw Hospital of Zhejiang University, No. 3 East Qingchun Road, Jianggan District, Hangzhou, 310016, Zhejiang Province, China
| | - Li Xu
- Department of Pulmonary and Critical Care Medicine, Sir Run Run Shaw Hospital of Zhejiang University, No. 3 East Qingchun Road, Jianggan District, Hangzhou, 310016, Zhejiang Province, China
| | - Shan Xu
- Department of Pulmonary and Critical Care Medicine, Sir Run Run Shaw Hospital of Zhejiang University, No. 3 East Qingchun Road, Jianggan District, Hangzhou, 310016, Zhejiang Province, China
| | - Jihong Zhu
- Department of Anesthesiology, Sir Run Run Shaw Hospital of Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Fengjie Wu
- Department of Pulmonary and Critical Care Medicine, The Second Hospital of Jiaxing, Jiaxing, Zhejiang Province, China
| | - Enguo Chen
- Department of Pulmonary and Critical Care Medicine, Sir Run Run Shaw Hospital of Zhejiang University, No. 3 East Qingchun Road, Jianggan District, Hangzhou, 310016, Zhejiang Province, China.
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Abbas AE. Commentary: Endoscopic device closure to fix the dam problem of postpneumonectomy bronchopleural fistula. JTCVS Tech 2020; 4:349-350. [PMID: 34318071 PMCID: PMC8306981 DOI: 10.1016/j.xjtc.2020.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/01/2020] [Accepted: 09/04/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Abbas E Abbas
- Division of Thoracic Surgery, Department of Thoracic Medicine and Surgery, Temple University Hospital and Fox Chase Comprehensive Cancer Center, Lewis Katz School of Medicine, Philadelphia, Pa
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S S, I T, H K. Endoscopic treatment of bronchopleural fistula using ethyl-2-cyanoacrylate: A report of two cases. Respir Med Case Rep 2020; 30:101123. [PMID: 32577364 PMCID: PMC7303975 DOI: 10.1016/j.rmcr.2020.101123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 11/15/2022] Open
Abstract
Bronchopleural fistula (BPF) is a serious complication after lung resection or chronic empyema. BPF often causes severe pneumonia or fatal airway bleeding due to bronchoarterial fistula. Although BPF often requires surgical treatment, another, more conservative treatment option is endoscopic bronchial occlusion for non-operable patients. Many endoscopic treatments have been reported. We report here two patients with BPF who underwent endoscopic bronchial occlusion. Patient 1 had postoperative BPF with empyema and Patient 2 had BPF due to chronic empyema. Because the BPF in Patient 1 was small, it could be successfully treated by endobronchial occlusion using only ethyl-2-cyanoacrylate. In contrast, because the BPF in Patient 2 was large, it could not be treated by endobronchial occlusion using ethyl-2-cyanoacrylate alone; it was successfully treated by endobronchial occlusion using the combination of ethyl-2-cyanoacrylate and a silicone spigot (endobronchial Watanabe spigot, EWS). When we attempt endoscopic bronchial occlusion with BPF for non-operable patients, ethyl-2-cyanoacrylate may be an option for small fistulas, while the combination of EWS and ethyl-2-cyanoacrylate may be suitable for large fistulas.
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Affiliation(s)
- Shigeki S
- Department of General Thoracic Surgery, Sagamihara Kyodo Hospital, Kanagawa, Japan
| | - Tomohiro I
- Department of General Thoracic Surgery, Sagamihara Kyodo Hospital, Kanagawa, Japan
| | - Kenichi H
- Department of General Thoracic Surgery, Sagamihara Kyodo Hospital, Kanagawa, Japan
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Goryunova AV, Shevchenko YS, Goryunov AV. [Cogitum in children's neurology and psychiatry (experience in the practical use)]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:83-90. [PMID: 31532592 DOI: 10.17116/hirurgia20190715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The authors review current data on the role of the synthetic aspartic acid analogue N-acetyaspartate (NAA) in various biochemical metabolic reactions in the CNS. Its importance as a biomarker for neuropsychiatric disorders identified using magnetic resonance spectroscopy (MRS) is noted. The authors present their own results of the use of cogitum, a synthetic analogue of NAA, in children with the effects of traumatic brain injury, mental retardation, hyperactivity disorder and in the complex therapy of schizotypal disorder. Effects of cogitum on cognitive deficit, asthenia are evaluated. The neurotrophic effect of the drug, which specifically affects cognitive and asthenic disorders in these diseases, is shown.
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Affiliation(s)
- A V Goryunova
- Russian Medical Academy for Continuous Professional Education, Moscow, Russia
| | - Yu S Shevchenko
- Russian Medical Academy for Continuous Professional Education, Moscow, Russia
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Ramai D, Bivona A, Latson W, Ofosu A, Ofori E, Reddy M, Adler DG. Endoscopic management of tracheoesophageal fistulas. Ann Gastroenterol 2018; 32:24-29. [PMID: 30598588 PMCID: PMC6302189 DOI: 10.20524/aog.2018.0321] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 09/24/2018] [Indexed: 02/06/2023] Open
Abstract
Tracheoesophageal fistulas (TEF) are pathologic communications between the trachea and esophagus. TEF can lead to significant respiratory distress that may result in lethal respiratory compromise, often due to recurrent and intractable infections. Through the use of endoscopy, some TEF can be successfully repaired using different approaches depending on the size, location, availability, and experience of the treating endoscopist. The aim of this manuscript is to provide an up-to-date review of the endoscopic management of TEF for gastroenterologists.
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Affiliation(s)
- Daryl Ramai
- Department of Medicine, The Brooklyn Hospital Center, NY (Daryl Ramai)
| | - Alexis Bivona
- School of Medicine, St George's University, True Blue, Grenada, WI (Alexis Bivona, William Latson)
| | - William Latson
- School of Medicine, St George's University, True Blue, Grenada, WI (Alexis Bivona, William Latson)
| | - Andrew Ofosu
- Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, NY (Andrew Ofosu)
| | - Emmanuel Ofori
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Huntsman Cancer Center, Salt Lake City, Utah (Emmanuel Ofori, Madhavi Reddy, Douglas G. Adler), USA
| | - Madhavi Reddy
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Huntsman Cancer Center, Salt Lake City, Utah (Emmanuel Ofori, Madhavi Reddy, Douglas G. Adler), USA
| | - Douglas G Adler
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Huntsman Cancer Center, Salt Lake City, Utah (Emmanuel Ofori, Madhavi Reddy, Douglas G. Adler), USA
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8
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Ono CR, Tedde ML, Scordamaglio PR, Buchpiguel CA. Pulmonary inhalation-perfusion scintigraphy in the evaluation of bronchoscopic treatment of bronchopleural fistula. Radiol Bras 2018; 51:385-390. [PMID: 30559556 PMCID: PMC6290752 DOI: 10.1590/0100-3984.2017.0133] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Abstract
Objective To evaluate the use of pulmonary inhalation-perfusion scintigraphy as an alternative method of investigation and follow-up in patients with bronchopleural fistula (BPF). Materials and Methods Nine patients with BPFs were treated through the off-label use of a transcatheter atrial septal defect occluder, placed endoscopically, and were followed with pulmonary inhalation-perfusion scintigraphy, involving inhalation, via a nebulizer, of 900-1300 MBq (25-35 mCi) of technetium-99m-labeled diethylenetriaminepentaacetic acid and single-photon emission computed tomography with a dual-head gamma camera. Results In two cases, there was a residual air leak that was not identified by bronchoscopy or the methylene blue test but was detected only by pulmonary inhalation-perfusion scintigraphy. Those results correlated with the evolution of the patients, both of whom showed late signs of air leak, which confirmed the scintigraphy findings. In the patients with complete resolution of symptoms and fistula closure seen on bronchoscopy, the scintigraphy was completely negative. In cases of failure to close the BPF, the scintigraphy confirmed the persistence of the air leak. In two patients, scintigraphy was the only method to show residual BPF, the fistula no longer being seen on bronchoscopy. Conclusion We found pulmonary inhalation-perfusion scintigraphy to be a useful tool for identifying a residual BPF, as well as being an alternative method of investigating BPFs and of monitoring the affected patients.
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Affiliation(s)
- Carla Rachel Ono
- Nuclear Medicine Division, Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil
| | - Miguel Lia Tedde
- Department of Thoracic Surgery, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor/HC-FMUSP), São Paulo, SP, Brazil
| | - Paulo Rogerio Scordamaglio
- Respiratory Endoscopy Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor/HC-FMUSP), São Paulo, SP, Brazil
| | - Carlos Alberto Buchpiguel
- Nuclear Medicine Division, Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil
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Scordamaglio PR, Tedde ML, Minamoto H, Assad RS, Fernandes PMP. Can total bronchopleural fistulas from complete stump dehiscence be endoscopically treated? Eur J Cardiothorac Surg 2017; 51:702-708. [PMID: 28082466 DOI: 10.1093/ejcts/ezw377] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 09/15/2016] [Indexed: 11/13/2022] Open
Abstract
Objectives Bronchopleural fistula (BPF) is an uncommon complication following a lung resection to address various conditions. BPFs are associated with high morbidity and mortality rates. This study evaluated the endoscopic treatment of 'total' BPFs using the Occlutech-Fígulla® cardiac device at a single centre. Methods We selected nine patients with chronic and complete BPFs. Under direct bronchoscopic visualization, the BPFs were treated using the Occlutech-Fígulla device. The patients were followed up for 12 months to determine the treatment level and complications. Results The procedure had a favourable outcome in three patients, resulting in complete fistula closure. Two patients had partial closure and showed improvements in their clinical conditions. In two other cases, closure of the bronchial stump was unsuccessful using this method. Two patients died from causes unrelated to the procedure or the device. During the follow-up period, no complications related to infection or device-related injuries were reported. Conclusions In patients without clinical conditions that require surgical treatment, the Occlutech-Fígulla cardiac device can be a safe and effective method for the endoscopic treatment of large BPFs resulting from complete dehiscence of a bronchial stump. No severe events were reported.
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Affiliation(s)
- Paulo Rogério Scordamaglio
- Division of Respiratory Endoscopy, Heart Institute (InCor) University of Sao Paulo School of Medicine, São Paulo, SP, Brazil
| | - Miguel Lia Tedde
- Thoracic Surgery Department, Heart Institute (InCor) University of Sao Paulo School of Medicine, São Paulo, SP, Brazil
| | - Hélio Minamoto
- Thoracic Surgery Department, Heart Institute (InCor) University of Sao Paulo School of Medicine, São Paulo, SP, Brazil
| | - Renato Samy Assad
- Cardiovascular Surgery Department, Heart Institute (InCor) University of Sao Paulo School of Medicine, São Paulo, SP, Brazil
| | - Paulo Manuel Pêgo Fernandes
- Thoracic Surgery Department, Heart Institute (InCor) University of Sao Paulo School of Medicine, São Paulo, SP, Brazil
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Abstract
Postoperative bronchopleural fistulas are serious and uncommon complications after pneumonectomy. Available therapeutic approaches are medical, endoscopic, and/or surgical. A 42-year-old man underwent left pneumonectomy. Three years later he was admitted to an intensive care unit with pneumonia of the remaining lung, severe respiratory insufficiency, and a bronchopleural fistula with an air fluid level filling in the pneumonectomy cavity. A left chest drain was placed, and broad-spectrum antibiotics and mechanical ventilation were administered. Because of the unstable clinical condition, a blind end endobronchial stent closed by a stapler was placed in the left bronchial stump. He improved in a couple of months and underwent definitive surgical sealing of the fistula.Endoscopic interventions are usually safe and free from associated complications. They are an excellent option, when patient's clinical condition is contraindication to immediate surgery.
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Cohen-Atsmoni S, Tamir A, Avni Y, Priel IE, Roth Y. Endoscopic Occlusion of Tracheoesophageal Fistula in Ventilated Patients Using an Amplatzer Septal Occluder. Indian J Otolaryngol Head Neck Surg 2015; 67:196-9. [PMID: 26075179 DOI: 10.1007/s12070-015-0842-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 03/03/2015] [Indexed: 11/29/2022] Open
Abstract
Acquired tracheoesophageal fistula (TEF) is a challenging, life threatening condition. It most commonly appears in critically ill patients requiring prolonged mechanical ventilation, who cannot withstand open neck or chest surgery. An endoscopic technique could be better tolerated by these patients. We present our experience using a cardiac Amplatzer ASD septal occluder for an endoscopic TEF repair in ventilation-dependent patients. Two high risk patients underwent the procedure under general anesthesia and close respiratory monitoring. In one patient the device was inserted through the trachea and in the other through the esophagus. In both cases fistula closure was achieved for different periods of time allowing the patients a temporary relief of symptoms. The procedure was well tolerated by the patients, and no significant adverse effect documented. The technique was successful as a temporary solution for unstable patients with TEFs and should be considered as a treatment modality for similar patients.
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Affiliation(s)
- Smadar Cohen-Atsmoni
- Department of Otolaryngology-Head & Neck Surgery, The Edith Wolfson Medical Center, Tel-Aviv University Sackler School of Medicine, P.O. Box 5, 58100 Holon, Israel
| | - Akiva Tamir
- Department of Pediatric Cardiology, The Edith Wolfson Medical Center, Tel-Aviv University Sackler School of Medicine, Holon, Israel
| | - Yona Avni
- Department of Gastroenterology, The Edith Wolfson Medical Center, Tel-Aviv University Sackler School of Medicine, Holon, Israel
| | - Israel E Priel
- Department of Pulmonary Medicine, The Edith Wolfson Medical Center, Tel-Aviv University Sackler School of Medicine, Holon, Israel
| | - Yehudah Roth
- Department of Otolaryngology-Head & Neck Surgery, The Edith Wolfson Medical Center, Tel-Aviv University Sackler School of Medicine, P.O. Box 5, 58100 Holon, Israel
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12
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Abstract
Fistula of bronchial stump developed in 246 (9.4%) cases of 2614 patients who were underwent pneumonectomy for lung cancer in 1964-2013. Mortality rate in case of bronchial fistulae was 17.9%. It was analyzed causes of this complication, an important role of infection for its development was emphasized. So prevention of wound infection is main prophylactic action. Postoperative pneumonia and bleeding are considerable risk factors. Clinico-anatomical type of tumor, stage and technique of bronchial stump treating don't affect incidence of fistulae. Bronchial stump covering is important intraoperative preventive measure. Treatment of this complication includes early drainage and pleural cavity sanitation and isolation of fistula from pleural cavity. Endoscopic procedures (impact with silver nitrate, trichloroacetic acid, laser) are preferred to solve the last problem. It allowed to achieve fistulae healing in 58.1% of cases.
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Affiliation(s)
- I Ia Motus
- Ural Research Institute for Phthisiopulmonology, Russian Ministry of Health, Sverdlovsk, Russia; The TB dispensary, Ekaterinburg, Russia
| | - A V Bazhenov
- Ural Research Institute for Phthisiopulmonology, Russian Ministry of Health, Sverdlovsk, Russia; The TB dispensary, Ekaterinburg, Russia
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Fruchter O, El Raouf BA, Abdel-Rahman N, Saute M, Bruckheimer E, Kramer MR. Efficacy of bronchoscopic closure of a bronchopleural fistula with amplatzer devices: long-term follow-up. ACTA ACUST UNITED AC 2014; 87:227-33. [PMID: 24434610 DOI: 10.1159/000357074] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 10/27/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND The development of a bronchopleural fistula (BPF) is associated with high rates of morbidity and mortality. We have developed a minimally invasive method of bronchoscopic BPF closure using Amplatzer devices (AD) and Amplatzer vascular plugs (AVP), with excellent short-term results. OBJECTIVES The aim of the present report was to explore the long-term outcome of patients treated by Amplatzer occluders and the durability of this novel modality of BPF treatment. METHODS A total of 31 central BPF in 31 patients (mean age 66.8 years, range 19-91) were sealed under moderate sedation bronchoscopically by either AD (n = 19) or AVP (n = 12). The average follow-up period was 17.6 months (range 1-68 months). RESULTS The main etiology for BPF was surgery (n = 24), pneumonectomy (n = 14) or lobectomy/segmentectomy (n = 10). The underlying disease was either primary (n = 19) or metastatic (n = 2) lung cancer. The immediate success rate was 96% as symptoms related to BPF disappeared in 30 of the 31 patients. Short-term (<30 days) mortality was 13% (4 patients). At follow-up, 14 patients (45%) are still alive. Out of 12 patients with late mortality, in 5 patients (41%) the death was directly related to cancer relapse, and no patient died due to BPF recurrence. CONCLUSION Endobronchial closure of BPF using both types of Amplatzer occluders (AD and AVP) is a minimally invasive effective modality of treatment with high safety profile and satisfactory long-term outcome considering the poor prognosis in this particular group of patients.
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Affiliation(s)
- Oren Fruchter
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Pasley T, Ruygrok PN, Kang N, O'Carroll M, Kolbe J, Morrice D. Closure of a broncho-pleural fistula using an atrial septal defect occluder. Heart Lung Circ 2013; 23:e92-5. [PMID: 24315634 DOI: 10.1016/j.hlc.2013.10.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 08/29/2013] [Accepted: 10/30/2013] [Indexed: 11/26/2022]
Abstract
Broncho-pleural fistulae (BPF) are recognised as a rare complication following pneumonectomy. We describe a patient, who after failing conservative treatment, underwent closure of a persistent fistula with an atrial septal defect (ASD) occluder. Additionally we review the literature regarding management of BPF and the emerging role of cardiac defect closure devices as a possible treatment option.
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Affiliation(s)
- Thomas Pasley
- Department of Cardiology, Auckland City Hospital, Private Bag 92024, Auckland, New Zealand; Department of Medicine, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142 New Zealand.
| | - Peter N Ruygrok
- Department of Cardiology, Auckland City Hospital, Private Bag 92024, Auckland, New Zealand; Department of Medicine, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142 New Zealand
| | - Nicolas Kang
- Department of Cardiac Surgery, Auckland City Hospital, Private Bag 92024, Auckland, New Zealand; Department of Medicine, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142 New Zealand
| | - Mark O'Carroll
- Department of Respiratory Medicine, Auckland City Hospital, Private Bag 92024, Auckland, New Zealand; Department of Medicine, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142 New Zealand
| | - John Kolbe
- Department of Respiratory Medicine, Auckland City Hospital, Private Bag 92024, Auckland, New Zealand; Department of Medicine, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142 New Zealand
| | - David Morrice
- Department of Cardiac Anaesthesia, Auckland City Hospital, Private Bag 92024, Auckland, New Zealand; Department of Medicine, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142 New Zealand
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Chamié F, Nigri DH, Haddad R. New frontier for intracardiac devices: Endobronchial occlusion of bronchopleural fistula with CERA device. Catheter Cardiovasc Interv 2013; 83:315-8. [DOI: 10.1002/ccd.25029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 04/15/2013] [Accepted: 05/12/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Francisco Chamié
- INTERCAT-Interventional Cardiology; Rio de Janeiro Brazil
- Samaritano Hospital; Rio de Janeiro Brazil
| | | | - Rui Haddad
- Samaritano Hospital; Rio de Janeiro Brazil
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Tedde ML, Scordamaglio PR, Rodrigues A, Minamoto H, Alfinito FS. Minimally Invasive Closure of Bronchopleural Fistulas. Chest 2011; 140:826. [DOI: 10.1378/chest.11-0719] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Passera E, Guanella G, Meroni A, Chiesa G, Rizzi A, Rocco G. Amplatzer Device and Vacuum-Assisted Closure Therapy to Treat a Thoracic Empyema With Bronchopleural Fistula. Ann Thorac Surg 2011; 92:e23-5. [DOI: 10.1016/j.athoracsur.2011.03.047] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 02/23/2011] [Accepted: 03/08/2011] [Indexed: 10/17/2022]
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Fruchter O, Kramer MR, Dagan T, Raviv Y, Abdel-Rahman N, Saute M, Bruckheimer E. Endobronchial closure of bronchopleural fistulae using amplatzer devices: our experience and literature review. Chest 2011; 139:682-687. [PMID: 21362655 DOI: 10.1378/chest.10-1528] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Bronchopulmonary fistulae (BPFs) are a severe complication of lobectomy and pneumonectomy and are associated with high rates of morbidity and mortality. We have developed a novel, minimally invasive method of central BPF closure using Amplatzer devices (ADs) that were originally designed for the transcatheter closure of cardiac defects. Ten patients with 11 BPFs (eight men and two women, aged 66.3±10.1 years [mean±SD]) were treated under conscious sedation with bronchoscopic closure of the BPFs using ADs. A nitinol double-disk occluder device was delivered under direct bronchoscopic guidance over a guidewire into the fistula. By extruding a disk on either side of the BPF, the fistula was occluded. Bronchography was performed by injecting contrast medium through the delivery sheath following the procedure to ensure correct device positioning. In nine patients, the procedure was successful and symptoms related to the BPF disappeared following closure by the AD. The results were maintained over a median follow-up period of 9 months. Therefore, we state that endobronchial closure using an AD is a safe and effective method for treatment of a postoperative BPF.
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Affiliation(s)
- Oren Fruchter
- Pulmonary Institute, Rabin Medical Center, Petah Tiqwa
| | | | - Tamir Dagan
- Department of Pediatric Cardiology, Schneider Children's Medical Center of Israel, Petah Tiqwa; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Raviv
- Pulmonary Institute, Rabin Medical Center, Petah Tiqwa
| | | | - Milton Saute
- Department of Cardiothoracic Surgery, Rabin Medical Center, Petah Tiqwa
| | - Elchanan Bruckheimer
- Department of Pediatric Cardiology, Schneider Children's Medical Center of Israel, Petah Tiqwa; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Tedde ML, Minamoto H, Scordamaglio PR, Rodrigues A, Moura EGH, Pedra CAC. Broncoscopic closure of tracheoesophageal fistulas. Ann Thorac Surg 2011; 91:1311. [PMID: 21440188 DOI: 10.1016/j.athoracsur.2010.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Revised: 08/04/2010] [Accepted: 09/07/2010] [Indexed: 10/18/2022]
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