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Zhu LM, Li CX, Gong XL, Xu ZM, Liu JL, Zhang HB. Clinical features of plastic bronchitis in children after congenital heart surgery. Ital J Pediatr 2024; 50:74. [PMID: 38637856 PMCID: PMC11027272 DOI: 10.1186/s13052-024-01650-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 04/07/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Plastic bronchitis (PB) can occur in patients who have undergone congenital heart surgery (CHS). This study aimed to investigate the clinical features of PB in children after CHS. METHODS We conducted a retrospective cohort study using the electronic medical record system. The study population consisted of children diagnosed with PB after bronchoscopy in the cardiac intensive care unit after CHS from May 2016 to October 2021. RESULTS A total of 68 children after CHS were finally included in the study (32 in the airway abnormalities group and 36 in the right ventricular dysfunction group). All children were examined and treated with fiberoptic bronchoscopy. Pathogens were detected in the bronchoalveolar lavage fluid of 41 children, including 32 cases in the airway abnormalities group and 9 cases in the right ventricular dysfunction group. All patients were treated with antibiotics, corticosteroids (intravenous or oral), and budesonide inhalation suspension. Children with right ventricular dysfunction underwent pharmacological treatment such as reducing pulmonary arterial pressure. Clinical symptoms improved in 64 children, two of whom were treated with veno-arterial extracorporeal membrane oxygenation (ECMO) due to recurrent PB and disease progression. CONCLUSIONS Children with airway abnormalities or right ventricular dysfunction after CHS should be alerted to the development of PB. Pharmacological treatment such as anti-infection, corticosteroids, or improvement of right ventricular function is the basis of PB treatment, while fiberoptic bronchoscopy is an essential tool for the diagnosis and treatment of PB. ECMO assistance is a vital salvage treatment for recurrent critically ill PB patients.
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Affiliation(s)
- Li-Min Zhu
- Department of Cardiac Intensive Care Unit, Shanghai Children' s Medical Center, Shanghai Jiaotong University School of Medicine, 1678 Dongfang Road, 200127, Shanghai, PR China
| | - Chun-Xiang Li
- Department of Cardiac Intensive Care Unit, Shanghai Children' s Medical Center, Shanghai Jiaotong University School of Medicine, 1678 Dongfang Road, 200127, Shanghai, PR China
| | - Xiao-Lei Gong
- Department of Cardiac Intensive Care Unit, Shanghai Children' s Medical Center, Shanghai Jiaotong University School of Medicine, 1678 Dongfang Road, 200127, Shanghai, PR China
| | - Zhuo-Ming Xu
- Department of Cardiac Intensive Care Unit, Shanghai Children' s Medical Center, Shanghai Jiaotong University School of Medicine, 1678 Dongfang Road, 200127, Shanghai, PR China
| | - Jin-Long Liu
- Institute of Pediatric Translational Medicine, Shanghai Children' s Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dongfang Road, 200127, Shanghai, PR China
| | - Hai-Bo Zhang
- Department of Cardiothoracic Surgery, Shanghai Children' s Medical Center, Shanghai Jiaotong University School of Medicine, 1678 Dongfang Road, 200127, Shanghai, PR China.
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Driesen BW, Voskuil M, Grotenhuis HB. Current Treatment Options for the Failing Fontan Circulation. Curr Cardiol Rev 2022; 18:e060122200067. [PMID: 34994331 PMCID: PMC9893132 DOI: 10.2174/1573403x18666220106114518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 10/22/2021] [Accepted: 11/16/2021] [Indexed: 11/22/2022] Open
Abstract
The Fontan operation was introduced in 1968. For congenital malformations, where biventricular repair is unsuitable, the Fontan procedure has provided a long-term palliation strategy with improved outcomes compared to the initially developed procedures. Despite these improvements, several complications merely due to a failing Fontan circulation, including myocardial dysfunction, arrhythmias, increased pulmonary vascular resistance, protein-losing enteropathy, hepatic dysfunction, plastic bronchitis, and thrombo-embolism, may occur, thereby limiting the life-expectancy in this patient cohort. This review provides an overview of the most common complications of Fontan circulation and the currently available treatment options.
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Affiliation(s)
- Bart W. Driesen
- Department of Pediatric Cardiology, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, Utrecht, The Netherlands
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Cardiology, Laurentius Ziekenhuis, Roermond, The Netherlands
| | - Michiel Voskuil
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Heynric B. Grotenhuis
- Department of Pediatric Cardiology, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, Utrecht, The Netherlands
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Pałyga-Bysiecka I, Polewczyk AM, Polewczyk M, Kołodziej E, Mazurek H, Pogorzelski A. Plastic Bronchitis—A Serious Rare Complication Affecting Children Only after Fontan Procedure? J Clin Med 2021; 11:jcm11010044. [PMID: 35011785 PMCID: PMC8745351 DOI: 10.3390/jcm11010044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 12/20/2021] [Accepted: 12/20/2021] [Indexed: 12/30/2022] Open
Abstract
Background: Plastic bronchitis (PB) may occur not only in children following palliative Fontan procedure but also in those without underlying heart disease. We aim to assess the clinical course, therapeutic measures, outcome, and follow-up of PB in children with congenital heart disease (CHD) and children without cardiac problems. Methods: This retrospective case series assessed children with PB admitted to hospital between 2015 and 2019. Parents or guardians of patients were contacted by e-mail or telephone between September 2017 and June 2019 to enquiry about recurrence of PB and strategy of treatment. The diagnosis of PB was based on the expectoration (spontaneous or during bronchoscopy) of endobronchial plugs. Results: This study delineated the clinical, histological, and laboratory features of plastic bronchitis in children following Fontan procedure (Group A) and in those without heart defects (Group B, non-CHD children). The main symptoms were cough accompanied by dyspnea, and hypoxemia with a decrease in oxygen saturation, often leading to acute respiratory failure. In children with CHD, the first episode of PB occurred at a relatively young age. Although chronic, i.e., lasting more than 3 weeks, inhaled therapy was implemented in both groups of patients, the recurrences of PB were observed. The mean time to PB recurrence after the first episode in Group A was longer than that in Group B (1.47 vs. 0.265 years, p = 0.2035). There was no re-episode with recurrence of PB in 3 cases out of 10 in total in Group A (30%) and 1 case out of 4 in total in Group B (25%). While the majority of children in Group A usually developed bronchial casts on the right side, the patients in Group B (without CHD) suffered from bronchial casts located only on the left side. Conclusions: Despite many similarities, clinical, histological, and laboratory studies in the children with plastic bronchitis after Fontan’s surgery and in children without heart defects suggest that there are differences in the course of the disease in patients without CHD, such as a more advanced age of the first episode of PB, the location of plastic casts on the left side, and a stronger role of inflammatory factors and mechanisms. Further research is needed to understand the pathophysiology of PB and choose the most appropriate therapy.
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Affiliation(s)
- Ilona Pałyga-Bysiecka
- First Department of Pediatrics, Swietokrzyskie Pediatric Center, 25-736 Kielce, Poland; (A.M.P.); (E.K.)
- Collegium Medicum, Jan Kochanowski University, 25-736 Kielce, Poland;
- Correspondence: ; Tel.: +48-413303326
| | - Aneta Maria Polewczyk
- First Department of Pediatrics, Swietokrzyskie Pediatric Center, 25-736 Kielce, Poland; (A.M.P.); (E.K.)
- Collegium Medicum, Jan Kochanowski University, 25-736 Kielce, Poland;
| | - Maciej Polewczyk
- Collegium Medicum, Jan Kochanowski University, 25-736 Kielce, Poland;
| | - Elżbieta Kołodziej
- First Department of Pediatrics, Swietokrzyskie Pediatric Center, 25-736 Kielce, Poland; (A.M.P.); (E.K.)
| | - Henryk Mazurek
- Department of Pneumology and Cystic Fibrosis, Institute of Tuberculosis and Lung Diseases, 03-700 Rabka-Zdrój, Poland; (H.M.); (A.P.)
| | - Andrzej Pogorzelski
- Department of Pneumology and Cystic Fibrosis, Institute of Tuberculosis and Lung Diseases, 03-700 Rabka-Zdrój, Poland; (H.M.); (A.P.)
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Wang L, Wang W, Sun JM, Ni SW, Ding JL, Zhu YL, Ding SG. Efficacy of fiberoptic bronchoscopy and bronchoalveolar lavage in childhood-onset, complicated plastic bronchitis. Pediatr Pulmonol 2020; 55:3088-3095. [PMID: 32770770 DOI: 10.1002/ppul.25016] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 08/05/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Plastic bronchitis (PB) is a rare, variable, and potentially fatal disease. This study aimed to assess the efficacy of fiberoptic bronchoscopy (FOB) and bronchoalveolar lavage (BAL) in treating children with PB. METHODS In total, 15 children with PB, between 2012 and 2020, were enrolled in our study. Within 12 hours of admission, FOB and BAL were performed and reviewed under local anesthesia and sedation. Before and after FOB, clinical findings and chest imaging were evaluated. RESULTS Regarding the onset of symptoms before FOB, all cases had prominent cough for 7.00 ± 4.55 days, and 14 had persistent high fever. In total, 13 cases had complete obstruction from bronchial casts, consistent with consolidated lesions; 2 had partial airway obstruction. Within 3 days, complete resolution was revealed in nine cases. Overall, six cases underwent repeated FOB (range, 2-3 times) for persistent atelectasis and airway obstruction. Except for two cases with type 2 PB, cast histology confirmed type 1 PB for all cases. Only eight children had minor intra- and post-procedure complications. Reverse transcription-polymerase chain reaction for Mycoplasma pneumoniae in sputum and BAL samples were positive in 13 cases. Next-generation sequencing of the BAL samples was positive for adenovirus and Human parainfluenza virus in one case, respectively. During 1 month to 7 years of follow-up, no patient developed PB recurrence, asthmatic attacks, or chronic cough. CONCLUSIONS Early FOB and BAL were effective in alleviating clinical findings, atelectasis, and airway obstruction. Serial FOB could be performed in patients with recurrent symptoms.
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Affiliation(s)
- Li Wang
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Wang Wang
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Jing-Min Sun
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Shen-Wang Ni
- Department of Clinical Laboratory, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Jun-Li Ding
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yu-Lin Zhu
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Sheng-Gang Ding
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
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Li Y, Williams RJ, Dombrowski ND, Watters K, Daly KP, Irace AL, Visner GA, Rahbar R, Fynn-Thompson F. Current evaluation and management of plastic bronchitis in the pediatric population. Int J Pediatr Otorhinolaryngol 2020; 130:109799. [PMID: 31812839 PMCID: PMC9187852 DOI: 10.1016/j.ijporl.2019.109799] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/20/2019] [Accepted: 11/22/2019] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To describe a multidisciplinary approach for the treatment of plastic bronchitis (PB) in children. METHODS Retrospective chart review of children with PB between 1997 and 2017. Data regarding clinical presentation, diagnosis, management, and outcomes were analyzed. RESULTS Of 34 patients presenting with PB, 24 had single ventricle (SV) heart disease, 9 had pulmonary disease, and one had no underlying disease. Median (IQR: interquartile range) age at the time of PB diagnosis was 5.5 years (IQR: 9.0). Presenting symptoms included cough productive of casts (n = 27, 79%), wheezing (n = 5, 15%), dyspnea (n = 18, 53%), hypoxia (n = 31, 91%), and respiratory failure (n = 9, 26%). Diagnosis was made based on clinical evaluation, bronchoscopy findings, and/or pathology of casts. Treatment methods included bronchoscopy for cast removal (25% of SV patients, 91% of non-SV patients), chest physiotherapy (SV: 92%, non-SV: 45%), albuterol (SV: 79%, non-SV: 73%), inhaled steroids (SV: 75%, non-SV: 18%), nebulized hypertonic saline (SV: 29%, non-SV: 9%), nebulized heparin (SV: 8%, non-SV: 55%), nebulized tissue plasminogen activator (tPA; SV: 33%, non-SV: 9%), inhaled Dornase Alfa (SV: 54%, non-SV: 9%), antibiotics (SV: 46%, non-SV: 45%), systemic steroids (SV: 13%, non-SV: 45%), and lymphatic embolization (SV: 8%, non-SV: 45%). Of SV patients, 11 had no recurrence, 5 underwent heart transplantation, one awaits transplant, and 3 died due to cardiac disease. Three patients with respiratory disease had recurrent PB and one died from MRSA pneumonia. CONCLUSION PB is a highly morbid disease with limited treatment options. Bronchoscopy and chest physiotherapy for airway clearance are among the most-utilized therapies.
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Affiliation(s)
- Youjin Li
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Ryan J Williams
- Department of Cardiology, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Natasha D Dombrowski
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Karen Watters
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, MA, 02115, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, 02115, USA
| | - Kevin P Daly
- Department of Cardiology, Boston Children's Hospital, Boston, MA, 02115, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, 02115, USA
| | - Alexandria L Irace
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Gary A Visner
- Department of Pediatrics, Harvard Medical School, Boston, MA, 02115, USA; Division of Pulmonary and Respiratory Diseases, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Reza Rahbar
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, MA, 02115, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, 02115, USA
| | - Francis Fynn-Thompson
- Department of Cardiology, Boston Children's Hospital, Boston, MA, 02115, USA; Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, 02115, USA; Department of Surgery, Harvard Medical School, Boston, MA, 02115, USA.
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Plastic Bronchitis in an AIDS Patient with Pulmonary Kaposi Sarcoma. Case Rep Pulmonol 2018; 2018:9736516. [PMID: 30363701 PMCID: PMC6180928 DOI: 10.1155/2018/9736516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 08/18/2018] [Indexed: 11/17/2022] Open
Abstract
Plastic bronchitis is the expectoration of bronchial casts in the mold of the tracheobronchial tree. It is a rare occurrence of unknown etiology that has been primarily described in children with congenital heart disease. In this case report, we present the first reported case of plastic bronchitis in a patient with pulmonary Kaposi sarcoma and underlying HIV infection.
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Eber E, Antón-Pacheco JL, de Blic J, Doull I, Faro A, Nenna R, Nicolai T, Pohunek P, Priftis KN, Serio P, Coleman C, Masefield S, Tonia T, Midulla F. ERS statement: interventional bronchoscopy in children. Eur Respir J 2017; 50:50/6/1700901. [DOI: 10.1183/13993003.00901-2017] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 08/08/2017] [Indexed: 12/25/2022]
Abstract
Paediatric airway endoscopy is accepted as a diagnostic and therapeutic procedure, with an expanding number of indications and applications in children. The aim of this European Respiratory Society task force was to produce a statement on interventional bronchoscopy in children, describing the evidence available at present and current clinical practice, and identifying areas deserving further investigation. The multidisciplinary task force panel performed a systematic review of the literature, focusing on whole lung lavage, transbronchial and endobronchial biopsy, transbronchial needle aspiration with endobronchial ultrasound, foreign body extraction, balloon dilation and occlusion, laser-assisted procedures, usage of airway stents, microdebriders, cryotherapy, endoscopic intubation, application of drugs and other liquids, and caregiver perspectives. There is a scarcity of published evidence in this field, and in many cases the task force had to resort to the collective clinical experience of the committee to develop this statement. The highlighted gaps in knowledge underline the need for further research and serve as a call to paediatric bronchoscopists to work together in multicentre collaborations, for the benefit of children with airway disorders.
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Robinson M, Smiley M, Kotha K, Udoji T. Plastic Bronchitis Treated With Topical Tissue-Type Plasminogen Activator and Cryotherapy. Clin Pediatr (Phila) 2016; 55:1171-5. [PMID: 26507250 DOI: 10.1177/0009922815614358] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - Kavitha Kotha
- Nationwide Children's Hospital, Columbus, OH, USA Ohio State University, Columbus, OH, USA
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