Chest
Volume 139, Issue 3, March 2011, Pages 682-687
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Selected Reports
Endobronchial Closure of Bronchopleural Fistulae Using Amplatzer Devices: Our Experience and Literature Review

https://doi.org/10.1378/chest.10-1528Get rights and content

Bronchopulmonary fistulae (BPFs) are a severe complication of lobectomy and pneumonectomy and are associated with high rates of morbidity and mortality. We have developed a novel, minimally invasive method of central BPF closure using Amplatzer devices (ADs) that were originally designed for the transcatheter closure of cardiac defects. Ten patients with 11 BPFs (eight men and two women, aged 66.3 ± 10.1 years [mean ± SD]) were treated under conscious sedation with bronchoscopic closure of the BPFs using ADs. A nitinol double-disk occluder device was delivered under direct bronchoscopic guidance over a guidewire into the fistula. By extruding a disk on either side of the BPF, the fistula was occluded. Bronchography was performed by injecting contrast medium through the delivery sheath following the procedure to ensure correct device positioning. In nine patients, the procedure was successful and symptoms related to the BPF disappeared following closure by the AD. The results were maintained over a median follow-up period of 9 months. Therefore, we state that endobronchial closure using an AD is a safe and effective method for treatment of a postoperative BPF.

Section snippets

Amplatzer Devices

The Amplatzer double-disk occluders have been described in detail15, 16, 17, 18 and represent a large family of devices designed originally for the transcatheter closure of cardiac septal defects or patent ductus arteriosus. The devices are made of nitinol mesh with a central connector between the disks. In this series, we used the Amplatzer Atrial Septal Occluder (Fig 1) and the Amplatzer Ductal Occluder II (AGA Medical; Golden Valley, Minnesota). The Amplatzer Atrial Septal Occluders have a

Results

Overall, 10 patients with 11 BPFs (eight men and two women, aged 66.3 ± 10.1 years [mean ± SD]) were treated in our institution with bronchoscopic AD implantation between January 2007 and December 2009. During the study period, all 10 patients with central BPFs who were referred to our institution were treated with bronchoscopic AD implantation. Written informed consent was obtained from all patients before the procedure, and all patients were informed of the fact that an off-label use of the

Discussion

We present our extended experience with a novel technique for the endobronchial closure of BPFs by the implantation of ADs. In all of the cases described, previous conservative and operative treatments were unsuccessful. The technique described herein enables direct visualization of the fistula using a flexible bronchoscope and a fluoroscope simultaneously, while allowing the operator to perform standard transcatheter procedures. The ADs have been used extensively to treat congenital heart

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