Aims & Objectives:
Vascular compression of the left main bronchus can occur due to left atrial enlargement, secondary to congenital or acquired heart disease. In severe cases this can result in ventilator dependence. A bronchial stent may improve symptoms. Metal stents have been associated with vascular erosion and deemed very high risk in this patient group.
We report our experience using a biodegradable polydioxanone stent in the left main bronchus in 5 children with cardiac disease and ventilator dependance.
Bedside flexible bronchoscopy was performed on paediatric intensive care and the anatomical relationship between cardiac structures and the bronchus was investigated with contrast enhanced computed tomography.
5 patients (weight range 1.8kg to 31kg) were identified and had biodegradable left main bronchial stents inserted under fluoroscopic guidance. Stents were custom designed and deliberately downsized by 50 to 70% of expected airway calibre.
Stents were inserted without complication under fluoroscopic guidance. All patients experienced improvement in symptoms over time. In three patients subsequent bronchial stenting was performed where degradation preceded relief of vascular compression. No stents migrated with no evidence of bronchial or vascular erosion. (figure 1 shows radiological progression in one patient pre and post stent insertion A to D). There was one death, unrelated to stenting and all remaining survivors are well at 2 year follow up.
The use of biodegradable stents was safe in this cohort of critically ill patients with vascular bronchial compression. There use provided a temporary improvement in airway calibre which aided weaning from mechanical ventilation and supported eventual cardiac recovery.