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Caruthers RL, Kempa M, Loo A, Gulbransen E, Kelly E, Erickson SR, Hirsch JC, Schumacher KR, Stringer KA. Demographic characteristics and estimated prevalence of Fontan-associated plastic bronchitis. Pediatr Cardiol 2013; 34:256-61. [PMID: 22797520 PMCID: PMC3586576 DOI: 10.1007/s00246-012-0430-5] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Accepted: 06/29/2012] [Indexed: 11/26/2022]
Abstract
Plastic bronchitis (PB) is a poorly understood disease that can complicate any underlying pulmonary disease. However, it appears to most often occur in patients with surgically palliated congenital heart disease, particularly after the Fontan procedure. Few data exist about the prevalence and etiology of PB in this population. In an effort to establish data about prevalence, we conducted a retrospective study of an existing Fontan surgery database (n = 654) comprised of data, including sex, age at date of surgery, alive/dead status, New York Heart Association classification at last follow-up, right-ventricular end-diastolic pressure and pulmonary artery pressure before Fontan surgery, and the presence of a Fontan fenestration. An initial medical record review of 173 patients in the database who were followed at the University of Michigan identified seven patients with PB resulting in an estimated prevalence of 4 %. Subsequently, 14 % of 211 surveyed patients reported that they presently expectorate mucus or fibrin plugs (casts). Demographic and clinical variables did not differ between patients with or without possible PB. Collectively, these findings suggest that Fontan patients presently with PB may range from 4 to 14 %, indicating potential under-diagnosis of the disease. There were no remarkable physical or hemodynamic indicators that differentiated patients with or without possible PB. These data also highlight the need for more elaborate, prospective studies to improve our understanding of PB pathogenesis so that more definitive diagnostic criteria for this devastating disease can be established and its prevalence more accurately determined.
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Affiliation(s)
- Regine L. Caruthers
- Department of Pharmacy, University of Michigan Hospitals and Health Centers, Ann Arbor, MI, USA
| | - Mollie Kempa
- Department of Pharmacy, University of Michigan Hospitals and Health Centers, Ann Arbor, MI, USA
| | - Angela Loo
- Department of Clinical, Social and Administrative Sciences, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Erin Gulbransen
- Department of Clinical, Social and Administrative Sciences, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Elizabeth Kelly
- Department of Clinical, Social and Administrative Sciences, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Steven R. Erickson
- Department of Clinical, Social and Administrative Sciences, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer C. Hirsch
- Department of Cardiac Surgery, Pediatric Surgery, School of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Kurt R. Schumacher
- Department of Pediatrics, Pediatric Cardiology, School of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Kathleen A. Stringer
- Department of Clinical, Social and Administrative Sciences, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
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