Strategies to Prevent Cast Formation in Patients with Plastic Bronchitis Undergoing Heart Transplantation

John J. Parent, Robert K. Darragh, Jeffrey G. Gossett, Thomas D. Ryan, Chet R. Villa, Angela Lorts, John Jefferies, Jeffrey Towbin, Clifford Chin

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1077-1079
Number of pages3
JournalPediatric Cardiology
Volume38
Issue number5
DOIs
StatePublished - Jun 1 2017

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Bronchitis
Heart Transplantation
Plastics
Bronchoscopy
Tissue Plasminogen Activator
Morbidity
Transplants
Respiratory Acidosis
Mortality
Artificial Respiration
Thrombosis
Transplantation
Therapeutics
Population

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Cardiology and Cardiovascular Medicine

Cite this

Parent, J. J., Darragh, R. K., Gossett, J. G., Ryan, T. D., Villa, C. R., Lorts, A., ... Chin, C. (2017). Strategies to Prevent Cast Formation in Patients with Plastic Bronchitis Undergoing Heart Transplantation. Pediatric Cardiology, 38(5), 1077-1079. https://doi.org/10.1007/s00246-017-1568-y

Strategies to Prevent Cast Formation in Patients with Plastic Bronchitis Undergoing Heart Transplantation. / Parent, John J.; Darragh, Robert K.; Gossett, Jeffrey G.; Ryan, Thomas D.; Villa, Chet R.; Lorts, Angela; Jefferies, John; Towbin, Jeffrey; Chin, Clifford.

In: Pediatric Cardiology, Vol. 38, No. 5, 01.06.2017, p. 1077-1079.

Research output: Contribution to journalArticle

Parent, John J. ; Darragh, Robert K. ; Gossett, Jeffrey G. ; Ryan, Thomas D. ; Villa, Chet R. ; Lorts, Angela ; Jefferies, John ; Towbin, Jeffrey ; Chin, Clifford. / Strategies to Prevent Cast Formation in Patients with Plastic Bronchitis Undergoing Heart Transplantation. In: Pediatric Cardiology. 2017 ; Vol. 38, No. 5. pp. 1077-1079.
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