Bronchoscopy in the Pediatric Cardiovascular Patient with Persistent Respiratory Pathology
Abstract
1. Introduction
2. Materials and Methods
2.1. Center
2.2. Inclusion Criteria
2.3. Methodology
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Zanetta, A.; Cuestas, G.; Rodriguez, H.; Tiscornia, C. Anillos vasculares: Obstrucción de vía aérea en niños. Serie de casos. Arch. Argent Pediatr. 2012, 110, e110–e113. [Google Scholar] [CrossRef]
- Rogers, D.J.; Cunnane, M.B.; Hartnick, C.J. Vascular compression of the airway: Establishing a functional algorithm. JAMA Otolaryngol. Head Neck Surg. 2013, 139, 586–591. [Google Scholar] [CrossRef] [PubMed]
- Filston, H.C.; Ferguson, T.B.; Oldham, H.N. Airway obstruction by vascular anomalies. Importance of telescopic bronchoscopy. Ann. Surg. 1987, 205, 541–549. [Google Scholar] [CrossRef]
- Kussman, B.D.; Geva, T.; McGowan, F.X. Cardiovascular causes of airway compression. Paediatr. Anaesth. 2004, 14, 60–74. [Google Scholar] [CrossRef] [PubMed]
- Lai, S.-H.; Liao, S.-L.; Wong, K.-S. Cardiovascular associated tracheobronchial obstruction in children. Cardiol. Young 2013, 23, 233–238. [Google Scholar] [CrossRef]
- Park, D.C.; Waldhausen, J.A.; Friedman, S.; Aberdeen, E.; Johnson, J. Tracheal compression by the great arteries in the mediastinum. Arch. Surg. 1971, 103, 626–632. [Google Scholar] [CrossRef] [PubMed]
- Bové, T.; Demanet, H.; Casimir, G.; Viart, P.; Goldstein, J.P.; Deuvaert, F.E. Tracheobronchial compression of vascular origin. Review of experience in infants and children. J. Cardiovasc. Surg. 2001, 42, 663–666. [Google Scholar]
- He, S.R.; Sun, Y.X.; Liu, Y.M.; Zhuang, J.; Zhong, J.; Liang, S.X.; Sun, X.; Lai, J.N. Airway obstruction caused by large blood vessel anomalies: Assessment by flexible bronchoscopy. Zhonghua Er Ke Za Zhi 2009, 47, 726–729. [Google Scholar]
- Yilmaz, M.; Ozkan, M.; Dogan, R.; Dermircin, M.; Ersoy, U.; Boke, E.; Pasaoglu, I. Vascular anomalies causing tracheoesophageal compression: A 20-year experience in diagnosis and management. Heart Surg. Forum. 2003, 6, 149–152. [Google Scholar]
- Efrati, O.; Gonik, U.; Modan-Moses, D.; Bielorai, B.; Barak, A.; Vardi, A.; Paret, G.; Mishaly, D.; Toren, A. The role of flexible fiberoptic bronchoscopy in evaluation of pulmonary diseases in children with congenital heart disease. Cardiol. Young 2007, 17, 140–144. [Google Scholar] [CrossRef]
- Ayten, O.; Özdemir, C.; Dalar, L.; Karaci, A.R. Bronchoscopic Management of Central Airway Obstruction in Children after Heart Surgery. Thorac. Cardiovasc. Surg. 2025, 73 (Suppl. 3), e39–e45. [Google Scholar] [CrossRef]
- Wu, J.H.; Wu, E.T.; Chou, H.W.; Wang, C.C.; Lu, F.L.; Wang, Y.C.; Huang, C.H.; Chen, S.J.; Chen, Y.S.; Huang, S.C. Airway Anomalies in Pediatric Patients After Surgery for Congenital Heart Disease: Single-Center Retrospective Cohort Study, Taiwan, 2017–2020. Pediatr. Crit. Care Med. 2024, 25, e438–e446. [Google Scholar] [CrossRef] [PubMed]
- Honnef, D.; Wildberger, J.E.; Das, M.; Hohl, C.; Mahnken, A.; Schnöring, H.; Vázquez-Jiménez, J.; Günther, R.W.; Staatz, G. Dose-reduced 16-slice multidetector-row spiral computed tomography in children with bronchoscopically suspected vascular tracheal stenosis—Initial results. Rofo 2006, 178, 425–431. [Google Scholar] [CrossRef]
- López Castillo, M.C.; Fernández Carretero, L.; Morales Martínez, A.; Ortiz Garrido, A.; Caro García, P. Flexible bronchoscopy in postoperative period in pediatric patients with congenital heart disease in a ICU. An. Pediatría (Engl. Ed.) 2022, 96, 362–365. [Google Scholar] [CrossRef]
- Backer, C.L.; Mongé, M.C.; Popescu, A.R.; Eltayeb, O.M.; Rastatter, J.C.; Rigsby, C. Vascular rings. Semin. Pediatr. Surg. 2016, 25, 165–175. [Google Scholar] [CrossRef]
- Lee, S.L.; Cheung, Y.F.; Leung, M.P.; Ng, Y.K.; Tsoi, N.S. Airway obstruction in children with congenital heart disease: Assessment by flexible bronchoscopy. Pediatr. Pulmonol. 2002, 34, 304–311. [Google Scholar] [CrossRef]
- Tan, H.; Zou, X.; Gong, K.; Yang, Y.; Wu, Z.; Liu, J.; Wu, S. Application of fibrobronchoscopy-guided aortic suspension in pediatric patients with bronchial compression resulting from repair of coarctation of the aorta: A case report. BMC Pediatr. 2025, 25, 373. [Google Scholar] [CrossRef] [PubMed]
- McLaren, C.A.; Elliott, M.J.; Roebuck, D.J. Vascular compression of the airway in children. Paediatr. Respir. Rev. 2008, 9, 85–94. [Google Scholar] [CrossRef] [PubMed]
- Wallis, C.; Alexopoulou, E.; Antón-Pacheco, J.L.; Bhatt, J.M.; Bush, A.; Chang, A.B.; Charatsi, A.M.; Coleman, C.; Depiazzi, J.; Douros, K.; et al. ERS statement on tracheomalacia and bronchomalacia in children. Eur. Respir. J. 2019, 54, 1900382. [Google Scholar] [CrossRef]
- Lee, E.Y.; Mason, K.P.; Zurakowski, D.; Waltz, D.A.; Ralph, A.; Riaz, F.; Boiselle, P.M. MDCT assessment of tracheomalacia in symptomatic infants with mediastinal aortic vascular anomalies: Preliminary technical experience. Pediatr. Radiol. 2008, 38, 82–88. [Google Scholar] [CrossRef]
- Chapotte, C.; Monrigal, J.-P.; Pezard, P.; Jeudy, C.; Subayi, J.-B.; De Brux, J.-L.; Cottineau, C.; Granry, J.-C. Airway compression in children due to congenital heart disease: Value of flexible fiberoptic bronchoscopic assessment. J. Cardiothorac. Vasc. Anesth. 1998, 12, 145–152. [Google Scholar] [CrossRef]
- Cerda, J.; Chacon, J.; Reichhard, C.; Bertrand, P.; Holmgren, N.L.; Claveria, C.; Sanchez, I. Flexible fiberoptic bronchoscopy in children with heart diseases: A twelve-year experience. Pediatr. Pulmonol. 2007, 42, 319–324. [Google Scholar] [CrossRef]
- Gaafar, A.H.; El-Noueam, K.I. Bronchoscopy versus multi-detector computed tomography in the diagnosis of congenital vascular ring. J. Laryngol. Otol. 2011, 125, 301–308. [Google Scholar] [CrossRef]
- Woo, S.J.; Woong-Han, K.; Kwangho, C.; JinHae, N.; Jin-Tae, K.; Jeong, R.L.; Yong, J.K.; Gi, B.K. Aortopexy with preoperative computed tomography and intraoperative bronchoscopy for patients with central airway obstruction after surgery for congenital heart disease: Postoperative computed tomography results and clinical outcomes. Pediatr. Cardiol. 2014, 35, 914–921. [Google Scholar] [CrossRef]
- Jhang, W.K.; Park, J.J.; Seo, D.M.; Goo, H.W.; Gwak, M. Perioperative evolution of airways in patients with arch obstruction and intracardiac defects. Ann. Thorac. Surg. 2008, 85, 1753–1758. [Google Scholar] [CrossRef] [PubMed]
- Grohmann, J.; Stiller, B.; Neumann, E.; Jakob, A.; Fleck, T.; Pache, G.; Siepe, M.; Höhn, R. Bronchial compression following pulmonary artery stenting in single ventricle lesions: How to prevent and how to decompress. Clin. Res. Cardiol. 2016, 105, 323–331. [Google Scholar] [CrossRef] [PubMed]
- Bandla, H.P.; Hopkins, R.L.; Beckerman, R.C.; Gozal, D. Pulmonary risk factors compromising postoperative recovery after surgical repair for congenital heart disease. Chest 1999, 116, 740–747. [Google Scholar] [CrossRef]
- JongEun, O.; Jung-Won, K.; Won-Jung, S.; Mijeung, G.; Pyung, H.P. Usefulness of intraoperative bronchoscopy during surgical repair of a congenital cardiac anomaly with possible airway obstruction. Three cases report. Korean J. Anesthesiol. 2016, 69, 71–75. [Google Scholar] [CrossRef]
- Nayak, P.P.; Sheth, J.; Cox, P.N.; Davidson, L.; Forte, V.; Manlhiot, C.; McCrindle, B.W.; Schwartz, S.M.; Solomon, M.; Van Arsdell, G.S.; et al. Predictive value of bronchoscopy after infant cardiac surgery: A prospective study. Intensiv. Care Med. 2012, 38, 1851–1857. [Google Scholar] [CrossRef] [PubMed]
- Yu, D.; Guo, Z.; You, X.; Peng, W.; Qi, J.; Sun, J.; Wu, K.; Li, X.; Mo, X. Long-term outcomes in children undergoing vascular ring division: A multi-institution experience. Eur. J. Cardiothorac. Surg. 2022, 61, 605–613. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- Naimo, P.S.; Fricke, T.A.; Donald, J.S.; Sawan, E.; d’Udekem, Y.; Brizard, C.P.; Konstantinov, I.E. Long-term outcomes of complete vascular ring division in children: A 36 year experience from a single institution. Interact. Cardiovasc. Thorac. Surg. 2017, 24, 234–239. [Google Scholar] [CrossRef] [PubMed]
- Schnapper, M.; Dalal, I.; Mandelberg, A.; Raucher Sternfeld, A.; Sasson, L.; Armoni Domany, K. Bronchoscopy in the management of children from developing countries undergoing congenital heart surgery. Pediatr. Pulmonol. 2022, 57, 1196–1201. [Google Scholar] [CrossRef]
- Chiu, P.; Zendejas, B.; Baird, C. Multidisciplinary approach to vascular rings and vascular-related aerodigestive compression: A clinical practice review. Transl. Pediatr. 2023, 12, 1258–1277. [Google Scholar] [CrossRef] [PubMed]
- Ghezzi, M.; Garancini, N.; De Santis, R.; Gianolio, L.; Zirpoli, S.; Mandelli, A.; Farolfi, A.; D’Auria, E.; Zuccotti, G.V. Recurrent Respiratory Infections in Children with Down Syndrome: A Review. Children 2024, 11, 246. [Google Scholar] [CrossRef] [PubMed]
Congenital Heart Disease | n (%) |
---|---|
Valvular heart disease | 21 (14.6) |
Transposition of the great vessels | 19 (13.2) |
Atrioventricular canal defect | 19 (13.2) |
Ventricular septal defect | 18 (12.5) |
Tetralogy of Fallot | 13 (9.0) |
Coarctation of the aorta | 13 (9.0) |
Atrial septal defect | 9 (6.3) |
Ductus arteriosus | 5 (3.5) |
Truncus | 5 (3.5) |
Double outlet ventricle | 4 (2.8) |
Single ventricle | 4 (2.8) |
Anomalous pulmonary drainage | 3 (2.8) |
Hypoplastic left heart | 2 (1.4) |
Aortopulmonary window | 1 (0.7) |
Total | 144 |
Findings n (% of Total Procedures) | Findings n (% of Total Procedures) |
---|---|
UPPER AIRWAY | |
Laryngotracheomalacia | 43 (38) |
Supra/subglottic stenosis | 37 (33) |
Vocal cord paralysis | 18 (16) |
Glottic edema | 5 (4.5) |
Total upper airway findings | 112 (56) |
LOWER AIRWAY | |
Extrinsic compression | 37 (42) |
Mucus plug | 23 (26) |
Nonspecific airway inflammation | 16 (18) |
Bronchomalacia | 9 (10) |
Tracheobronchial fistula | 2 (2.3) |
Plastic bronchitis | 1 (1.1) |
Total lower airway findings | 88 (44) |
Indications for Fiberoptic Bronchoscopy | n (%) |
---|---|
Stridor | 85 (42.7) |
Persistent atelectasis | 49 (24.6) |
Intubation-extubation failure | 18 (9) |
Pump egress failure | 14 (7) |
Recurrent pneumonia | 13 (6.5) |
Hemoptysis | 11 (5.5) |
Persistent respiratory distress | 9 (4.5) |
Total | 199 |
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Ariza-Jimenez, A.-B.; Valverde Montoro, D.; Caro Aguilera, P.; Perez Ruiz, E.; Perez Frias, F.J. Bronchoscopy in the Pediatric Cardiovascular Patient with Persistent Respiratory Pathology. J. Clin. Med. 2025, 14, 6606. https://doi.org/10.3390/jcm14186606
Ariza-Jimenez A-B, Valverde Montoro D, Caro Aguilera P, Perez Ruiz E, Perez Frias FJ. Bronchoscopy in the Pediatric Cardiovascular Patient with Persistent Respiratory Pathology. Journal of Clinical Medicine. 2025; 14(18):6606. https://doi.org/10.3390/jcm14186606
Chicago/Turabian StyleAriza-Jimenez, Ana-Belen, Delia Valverde Montoro, Pilar Caro Aguilera, Estela Perez Ruiz, and Francisco Javier Perez Frias. 2025. "Bronchoscopy in the Pediatric Cardiovascular Patient with Persistent Respiratory Pathology" Journal of Clinical Medicine 14, no. 18: 6606. https://doi.org/10.3390/jcm14186606
APA StyleAriza-Jimenez, A.-B., Valverde Montoro, D., Caro Aguilera, P., Perez Ruiz, E., & Perez Frias, F. J. (2025). Bronchoscopy in the Pediatric Cardiovascular Patient with Persistent Respiratory Pathology. Journal of Clinical Medicine, 14(18), 6606. https://doi.org/10.3390/jcm14186606