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Bronchial decompression following repair of absent pulmonary valve: Fine-tuning by procedural fiberoptic bronchoscopy.

ABSTRACT: Marked aneurysmal dilation of the central and branch pulmonary arteries in utero in patients with tetralogy of Fallot with absent pulmonary valve can often exhibit extrinsic compression of the trachea and bronchi. The major morbidity in these patients remains postoperative ventilation issues. This case report highlights the role of intraoperative bronchoscopy in providing guidance for obtaining optimal bronchial decompression that was achieved by an initial pulmonary arteriopexy followed by an aortopexy.

SUBMITTER: Maddali MM

PROVIDER: S-EPMC8404592 | biostudies-literature | 2021 Jul-Sep

REPOSITORIES: biostudies-literature

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Bronchial decompression following repair of absent pulmonary valve: Fine-tuning by procedural fiberoptic bronchoscopy.

Maddali Madan M MM Al-Kindi Hamood N HN Kandachar Pranav S PS Abolwafa Amr A Ahmed Ahmed E AE

Annals of cardiac anaesthesia 20210701 3

Marked aneurysmal dilation of the central and branch pulmonary arteries in utero in patients with tetralogy of Fallot with absent pulmonary valve can often exhibit extrinsic compression of the trachea and bronchi. The major morbidity in these patients remains postoperative ventilation issues. This case report highlights the role of intraoperative bronchoscopy in providing guidance for obtaining optimal bronchial decompression that was achieved by an initial pulmonary arteriopexy followed by an a ...[more]

PMID: 34269279

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Project description:BackgroundThe inflated balloon of a bronchial blocker (BB) obstructs the mainstem bronchus, allowing controlled ventilation of one lung while collapsing the other for lung isolation during thoracic surgery. We compared the effects of lung isolation using electromagnetic navigation bronchoscopy (ENB)-guided versus fiberoptic bronchoscopy (FOB)-guided BB placement to provide a novel BB positioning method for airway management during thoracic anesthesia.MethodsWe randomly divided 106 patients who underwent elective one-lung ventilation (OLV) with intraoperative ENB usage into ENB and FOB groups. We compared subjective lung collapse scores, time required for correct BB placement, incidence of BB malposition, and frequency of intraoperative BB repositioning with FOB between the groups. Heart rate (HR) and mean arterial pressure were recorded before intubation of single-lumen tracheal tube, and before and after BB positioning. Blood gas levels were measured before and at 10 and 30 min after initiating OLV. Postoperative follow-up indices, including blood cell analysis, C-reactive protein levels, and pulmonary complications, were also recorded.ResultsThe subjective lung collapse score was significantly higher in the ENB group than in the FOB group [9.08 (1.36) vs. 8.24 (1.93), P=0.01]. The time required for correct BB placement was significantly shorter in the ENB group than in the FOB group [13.00 (10.00, 20.25) vs. 49.00 (35.00, 75.00), P<0.001]. However, the incidence of BB malposition, frequency of intraoperative BB repositioning with FOB, HR, mean arterial and peak airway pressure before and after BB positioning, arterial blood gas analysis, and postoperative follow-up indices did not differ significantly between the two groups.ConclusionsENB-guided BB positioning is an efficient method of lung isolation, demonstrating superior and more rapid lung collapse effects compared with conventional FOB-guided BB placement.Trial registrationThe trial was registered on China Clinical Trial Registry (registration No. ChiCTR2300076133).

Dataset Information

Bronchial decompression following repair of absent pulmonary valve: Fine-tuning by procedural fiberoptic bronchoscopy.

Publications

Bronchial decompression following repair of absent pulmonary valve: Fine-tuning by procedural fiberoptic bronchoscopy.

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