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Troubled Judging of Bronchus Compression Due to Contrast-Filled Balloon in Three-Dimensional Rotational Angiography

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Abstract

Three-dimensional rotational angiography (3DRA) is a suitable technique to detect the risk of left main bronchus (LMB) compression during left pulmonary artery (LPA) stenting in partial cavopulmonary connection and total cavopulmonary connection (TCPC). We report on a case of a 4-year-old boy with hypoplastic left heart syndrome and TCPC in which 3DRA and bronchoscopy gave conflicting information on airway patency during balloon interrogation. The balloon with high contrast concentration created a severe artifact impeding visibility of the LMB. Simultaneous flexible bronchoscopy revealed an unobstructed LMB. Repeated 3DRAs with lower contrast concentration had no artifact and showed a patent airway in accordance with the bronchoscopy. Conventional LPA stenting was performed without indication for stent ovalization. The benefit of low contrast concentration in the interrogation balloon was demonstrated in a second case of an 11-year-old boy with TCPC. The margins of the LPA and LMB were clearly visible without blank-out artifact. Oval stent procedure was necessary to prevent LMB compression. When 3DRA is used for vessel–airway interrogation, the balloon contrast concentration should be low in order to avoid artifacts. When in doubt, simultaneous flexible bronchoscopy can overcome the dilemma in airway judgment.

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References

  1. Downing TE, Allen KY, Goldberg DJ, Rogers LS, Ravishankar C, Rychik J, Fuller S, Montenegro LM, Steven JM, Gillespie MJ, Rome JJ, Spray TL, Nicolson SC, William Gaynor J, Glatz AC (2017) Surgical and catheter-based reinterventions are common in long-term survivors of the Fontan operation. Circ Cardiovasc Interv 10(9):e004924. https://doi.org/10.1161/CIRCINTERVENTIONS.116.004924

    Article  PubMed  Google Scholar 

  2. Rahkonen O, Chaturvedi RR, Benson L, Honjo O, Caldarone CA, Lee KJ (2015) Pulmonary artery stenosis in hybrid single-ventricle palliation: high incidence of left pulmonary artery intervention. J Thorac Cardiovasc Surg 149(4):1102–1110. https://doi.org/10.1016/j.jtcvs.2014.11.080

    Article  PubMed  Google Scholar 

  3. Ovroutski S, Ewert P, Alexi-Meskishvili V, Hölscher K, Miera O, Peters B, Hetzer R, Berger F (2009) Absence of pulmonary artery growth after Fontan operation and its possible impact on late outcome. Ann Thorac Surg 87(3):826–831. https://doi.org/10.1016/j.athoracsur.2008.10.075

    Article  PubMed  Google Scholar 

  4. Berman DP, Khan DM, Gutierrez Y, Zahn EM (2012) The use of three-dimensional rotational angiography to assess the pulmonary circulation following Cavo-pulmonary connection in patients with single ventricle. Catheter Cardiovasc Interv 80(6):922–930. https://doi.org/10.1002/ccd.23461

    Article  PubMed  Google Scholar 

  5. Ferandos C, El-Said H, Hamzeh R, Moore JW (2009) Adverse impact of vascular stent “mass effect” on airways. Catheter Cardiovasc Interv 74(1):132–136. https://doi.org/10.1002/ccd.21945

    Article  PubMed  Google Scholar 

  6. Moszura T, Mazurek-Kula A, Dryzek P, Sysa A (2010) Bronchial compression as adverse effect of left pulmonary artery stenting in a patient with hypoplastic left heart syndrome. Pediatr Cardiol 31(4):530–533. https://doi.org/10.1007/s00246-009-9601-4

    Article  CAS  PubMed  Google Scholar 

  7. Ebrahim M, Hagood J, Moore J, El-Said H (2015) Bronchoscopic guidance of endovascular stenting limits airway compression. Catheter Cardiovasc Interv 85(5):832–836. https://doi.org/10.1002/ccd.25772

    Article  PubMed  Google Scholar 

  8. O’Byrne ML, Rome N, Santamaria RW, Hallbergson A, Glatz AC, Dori Y, Gillespie MJ, Goldfarb S, Haas AR, Rome JJ (2016) Intra-procedural Bronchoscopy to Prevent Bronchial Compression During Pulmonary Artery Stent Angioplasty. Pediatr Cardiol 37(3):433–441. https://doi.org/10.1007/s00246-015-1296-0

    Article  PubMed  Google Scholar 

  9. Borik S, Volodina S, Chaturvedi R, Lee KJ, Benson LN (2015) Three-dimensional rotational angiography in the assessment of vascular and airway compression in children after a cavopulmonary anastomosis. Pediatr Cardiol 36(5):1083–1089. https://doi.org/10.1007/s00246-015-1130-8

    Article  PubMed  Google Scholar 

  10. van der Stelt F, Krings GJ, Molenschot MC, Breur JM (2018) Additional value of three-dimensional rotational angiography in the diagnostic evaluation and percutaneous treatment of children with univentricular hearts. EuroIntervention 14(6):637–644. https://doi.org/10.4244/EIJ-D-17-01034

    Article  PubMed  Google Scholar 

  11. Krings GJ, van der Stelt F, Molenschot MMC, Breur JMPJ (2020) Oval stenting in left pulmonary artery stenosis: a novel double balloon technique to prevent airway compression in single ventricle. EuroIntervention 15(13):1209–1215. https://doi.org/10.4244/EIJ-D-18-01079

    Article  PubMed  Google Scholar 

  12. Kang SL, Armstrong A, Krings G, Benson L (2019) Three-dimensional rotational angiography in congenital heart disease: Present status and evolving future. Congenit Heart Dis 14(6):1046–1057. https://doi.org/10.1111/chd.12838

    Article  PubMed  Google Scholar 

  13. Noonan P, Kudumula V, Anderson B, Ramchandani B, Miller P, Dhillon R, Mehta C, Stumper O (2016) Stenting of the left pulmonary artery after palliation of hypoplastic left heart syndrome. Catheter Cardiovasc Interv 88(2):225–232. https://doi.org/10.1002/ccd.26450

    Article  PubMed  Google Scholar 

  14. Hosein RB, Clarke AJ, McGuirk SP, Griselli M, Stumper O, De Giovanni JV, Barron DJ, Brawn WJ (2007) Factors influencing early and late outcome following the Fontan procedure in the current era. The “two commandments”? Eur J Cardiothorac Surg 31(3):344–353. https://doi.org/10.1016/j.ejcts.2006.11.043

    Article  PubMed  Google Scholar 

  15. Truong UT, Fagan TE, Deterding R, Ing RJ, Fonseca BM (2015) Use of rotational angiography in assessing relationship of the airway to vasculature during cardiac catheterization. Catheter Cardiovasc Interv 86(6):1068–1077. https://doi.org/10.1002/ccd.26004

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatric Cardiology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, P.O. Box 85090, 3508 AB, Utrecht, The Netherlands

    Anouk S. Moerdijk, Johannes M. P. J. Breur, Mirella M. C. Molenschot & Gregor J. Krings

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  1. Anouk S. Moerdijk
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  2. Johannes M. P. J. Breur
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  3. Mirella M. C. Molenschot
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  4. Gregor J. Krings
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Correspondence to Gregor J. Krings.

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Krings is a member of the advisory board of Siemens Healthineers and consultant for Edwards Lifesciences. The other authors have no conflict of interest to declare.

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Moerdijk, A.S., Breur, J.M.P.J., Molenschot, M.M.C. et al. Troubled Judging of Bronchus Compression Due to Contrast-Filled Balloon in Three-Dimensional Rotational Angiography. Pediatr Cardiol 43, 704–708 (2022). https://doi.org/10.1007/s00246-021-02775-y

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  • DOI: https://doi.org/10.1007/s00246-021-02775-y

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