Original articleCongenital heart surgeryA Multifaceted Approach to the Management of Plastic Bronchitis After Cavopulmonary Palliation
Section snippets
Patients and Methods
All patients with a clinical or pathologic diagnosis of plastic bronchitis managed through the Single Ventricle Survivorship Program at the Children's Hospital of Philadelphia between January 1, 2003, and August 22, 2013, were eligible for inclusion in this retrospective case series. Hospital records were reviewed for demographic information and pertinent clinical characteristics. Demographic and anatomic characteristics were summarized by standard descriptive summaries and are expressed as
Results
Fourteen patients met the inclusion criteria. Demographic characteristics are summarized in Table 1. Patients were 86% male and 93% white. Hypoplastic left heart syndrome was present in 6 patients (43%). Thirteen patients underwent Fontan completion at median age of 2.7 years (range, 1.2 to 4.1 years), with an extracardiac conduit in 6 patients (46%), lateral tunnel in 6 (46%), and a catheter-based covered stent baffle (performed at an another institution) in 1 (8%). One patient was not deemed
Comment
Our experience demonstrates that plastic bronchitis after Fontan operation can be successfully managed with complete elimination or a substantial reduction in symptoms. This is achieved through a step-wise, individually tailored strategy aimed at improving Fontan circulation through pharmacologic, catheter-based, or surgical treatments, or a combination of these, along with aggressive use of aerosolized t-PA to maintain airway patency (Table 3).
Plastic bronchitis is a serious, potentially
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