1. Outcome of long-term complications after permanent metallic left bronchial stenting in children.
- Author
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Serio P, Nenna R, Di Maurizio M, Avenali S, Leone R, Baggi R, Arcieri L, Murzi B, Quarti A, Pozzi M, Mirabile L, and Midulla F
- Subjects
- Child, Child, Preschool, Female, Humans, Infant, Infant, Newborn, Male, Retrospective Studies, Stents statistics & numerical data, Tomography, X-Ray Computed, Treatment Outcome, Bronchi surgery, Bronchial Diseases surgery, Postoperative Complications therapy, Stents adverse effects
- Abstract
Objectives: We describe the way we treated 7 children with critical long-term complications after metallic balloon-expandable stenting in the left mainstem bronchus., Methods: Endoscopic follow-up included a first bronchoscopy 3 weeks after stenting, then monthly for 3 months, every 4-6 months up to 1 year and at scheduled times to calibrate stent diameter up to final calibration. When major complications occurred, patients underwent chest computed tomographic angiography., Results: In 1 of the 7 children (median age 2.8 years), metallic left bronchial stenting served as a bridge to surgery. After a median 4-year follow-up, all 7 children experienced recurrent stent ovalizations with stent breakage in 3 and erosion in 1. In 4 children, computed tomographic angiography showed abundant peribronchial fibrous tissue, in 2 left mediastinal rotation and in 1 displacement along the left bronchus after pulmonary re-expansion as the cause of stent-related complication. Of the 7 children, 6 underwent surgery (5 posterior aortopexy and 1 section of the ligamentum arteriosus) and 3 required nitinol stents placement within the metallic ones. One patient completed the follow-up, and 1 patient was lost to follow-up. All 5 remaining children still have permanent bronchial stents in place, patent and re-epithelialized after a median 10.5-year follow-up. There were no deaths., Conclusions: Satisfactory anatomical relationships when children have stents placed in the left mainstem bronchus alone do not guarantee the final success. Several mechanisms intervene to cause critical stent-related complications in children during growth. Permanent metallic stents should be used carefully, and only in selected patients., (© The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
- Published
- 2018
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