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Stramiello JA, Friesen TL, Rao A, Ratnayaka K, Moore J, El-Said H, Brigger MT. Aortopulmonary collaterals: An etiology for pediatric tracheostomy hemorrhage. Int J Pediatr Otorhinolaryngol 2022; 158:111123. [PMID: 35483154 DOI: 10.1016/j.ijporl.2022.111123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 03/26/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To report a single-institution's experience of symptomatic aortopulmonary collaterals presenting as tracheostomy tube hemorrhage. STUDY DESIGN Retrospective case series and Contemporary Review. SETTING Tertiary care children's hospital. METHODS Retrospective review, from 2015 to 2020, of patients <18 years old who were treated for tracheostomy hemorrhage with endovascular embolization of aortopulmonary collateral (APC) vessels. RESULTS 4 patients were identified, 2 males and 2 females, ages 15 months-to 14 years-old, with a range of cyanotic congenital heart diseases. Direct laryngoscopy and bronchoscopy were necessary for excluding proximal airway sources. Chest computed tomography angiography did not localize pulmonary hemorrhage, but helped identify aortopulmonary collaterals. Cardiac catheterization was both diagnostic and therapeutic with use of endovascular embolization techniques by pediatric interventional cardiology and interventional radiology. Previously reported APC-related pulmonary hemorrhages occurred in significantly different settings compared to our patients, and evaluation by an otolaryngologist was key to rule out upper airway etiologies. CONCLUSION Symptomatic aortopulmonary collaterals is an important etiology in pediatric tracheostomy tube hemorrhage in patients with cyanotic congenital heart disease.
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Affiliation(s)
- Joshua A Stramiello
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of California San Diego, La Jolla, CA, 92037, USA
| | - Tzyynong L Friesen
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of California San Diego, La Jolla, CA, 92037, USA; Division of Pediatric Otolaryngology, Rady Children's Hospital San Diego, San Diego, CA, 92123, USA
| | - Aparna Rao
- Division of Pulmonary/Respiratory Medicine, Department of Pediatrics, Rady Children's Hospital San Diego, San Diego, CA, 92123, USA
| | - Kanishka Ratnayaka
- Division of Cardiology, Department of Pediatrics, University of California San Diego, La Jolla, CA, 92037, USA; Division of Pediatric Cardiology, Department of Pediatrics, Rady Children's Hospital San Diego, San Diego, CA, 92123, USA
| | - John Moore
- Division of Cardiology, Department of Pediatrics, University of California San Diego, La Jolla, CA, 92037, USA; Division of Pediatric Cardiology, Department of Pediatrics, Rady Children's Hospital San Diego, San Diego, CA, 92123, USA
| | - Howaida El-Said
- Division of Cardiology, Department of Pediatrics, University of California San Diego, La Jolla, CA, 92037, USA; Division of Pediatric Cardiology, Department of Pediatrics, Rady Children's Hospital San Diego, San Diego, CA, 92123, USA
| | - Matthew T Brigger
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of California San Diego, La Jolla, CA, 92037, USA; Division of Pediatric Otolaryngology, Rady Children's Hospital San Diego, San Diego, CA, 92123, USA.
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Jin C, Lin N, Yang S, Yan C, Li S, Wu X, Zhu J. Postoperative nursing care of a child with pulmonary artery displacement combined with slide tracheobronchial plasty. Nurs Crit Care 2022; 28:446-453. [PMID: 35534433 DOI: 10.1111/nicc.12774] [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: 12/07/2021] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Generally, pulmonary artery sling operation involves the pulmonary artery transplantation to be cut off. Nursing care is focused on the postoperative pulmonary vascular anastomosis, respiratory tract, and blood pressure after surgery. We report the case of an infant who underwent pulmonary artery tracheal transposition combined with Slide keratoplasty, where the pulmonary artery transplantation was not cut off. We highlight that postoperative pulmonary artery blood flow to the unobstructed airway and airway reconstruction surgery should be focused on to help children recover and ensure successful surgery. METHODS To report the postoperative nursing experience of one patient with pulmonary artery sling undergoing pulmonary tracheal transposition combined with Slide arthroplasty. RESULTS Throughout the postoperative care, airway management should be focused on to maintain circulation stability in the early postoperative period, and corresponding measures such as posture management, atomization inhalation, and improved chest physical therapy should be applied according to the special surgical method of the case in order to reduce airway complications and to improve the surgical success rate of children with pulmonary artery sling undergoing pulmonary tracheal transposition combined with Slide arthroplasty. CONCLUSION In similar cases, after pulmonary tracheal transposition and Slide angioplasty, the doctors and nurses should pay attention to early circulation stability and focus on airway management through careful treatment and nursing, so as to promote the child's recovery.
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Affiliation(s)
- Chendi Jin
- Cardiac Intensive Care Unit, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Nan Lin
- Nursing Department, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Shanfeng Yang
- Cardiac Intensive Care Unit, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Chuanchuan Yan
- Cardiac Intensive Care Unit, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Shuaini Li
- Cardiac Intensive Care Unit, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Xiujing Wu
- Cardiac Intensive Care Unit, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jihua Zhu
- Nursing Department, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
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