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Article: Airway obstruction in children with congenital heart disease: Assessment by flexible bronchoscopy
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TitleAirway obstruction in children with congenital heart disease: Assessment by flexible bronchoscopy
 
AuthorsLee, SL2 1
Cheung, YF1
Leung, MP1
Ng, YK2
Tsoi, NS2
 
Issue Date2002
 
PublisherJohn Wiley & Sons, Inc. The Journal's web site is located at http://www3.interscience.wiley.com/cgi-bin/jhome/39249
 
CitationPediatric Pulmonology, 2002, v. 34 n. 4, p. 304-311 [How to Cite?]
DOI: http://dx.doi.org/10.1002/ppul.10164
 
AbstractWe assessed the spectrum of airway disorders in children with congenital cardiac anomalies, and reviewed our experience in using flexible bronchoscopy for assessment of airway problems in this patient group. The clinical records, flexible bronchoscopic findings, and cardiac imaging results of pediatric cardiac patients who presented with either clinical or radiological signs of airway obstruction between 1992-1999 were reviewed. Frexible bronchoscopic assessment was performed with the patients under sedation and topical anesthesia, using one of two bronchoscopes, i.e., an Olympus BFN20 or Olympus BF3C20. Of a total of 52 patients, 33 had acyanotic cardiovascular lesions, the commonest being left-to-right shunts (61%), while 19 had cyanotic heart lesions, with right ventricular outflow obstruction being the commonest (63%). Twenty-seven patients had undergone either surgical or transcatheter interventions. The median age at bronchoscopic assessment was 6 months (range, 4 days to 6 years). None of the patients developed significant procedural complications. A definitive diagnosis was made in 48 (92%) patients, 8 of whom had abnormalities involving only the upper airways, 35 only the lower airways, and 5 both. Abnormalities of the upper airway included laryngomalacia (n = 6), subglottic stenosis (n = 3), pharyngeal collapse (n = 2), and 1 each of choanal stenosis and supraglottitis. Extrinsic compression was the commonest lower airway abnormality that was found in 27/40 patients (67%), with a predilection for the left main bronchus (18/27, 67%). The structures that caused extrinsic compression included dilated pulmonary arteries with or without left atrial dilation (n = 20), an anomalous aortic or pulmonary arterial course (n = 3), a dilated aorta (n = 1), and a shunt (n = 1), but were not obvious in 2 patients. Intrinsic lower airway abnormalities included bronchomalacia (n = 4), tracheal stenosis (n = 4), and one each of variant bronchial bifurcation and a pouch arising from the tracheal wall. Intraluminal mucus plugging of the lower airways occurred in the remaining 3 patients. Children with congenital heart disease are at risk of airway obstruction both before and after surgery. Flexible bronchoscopy, being safe and effective in diagnosing airway disorders in this patient group, should be considered as the first line of investigation. © 2002 Wiley-Liss, Inc.
 
ISSN8755-6863
2013 Impact Factor: 2.297
2013 SCImago Journal Rankings: 1.092
 
DOIhttp://dx.doi.org/10.1002/ppul.10164
 
ISI Accession Number IDWOS:000178269800008
 
ReferencesReferences in Scopus
 
DC FieldValue
dc.contributor.authorLee, SL
 
dc.contributor.authorCheung, YF
 
dc.contributor.authorLeung, MP
 
dc.contributor.authorNg, YK
 
dc.contributor.authorTsoi, NS
 
dc.date.accessioned2012-10-30T06:07:29Z
 
dc.date.available2012-10-30T06:07:29Z
 
dc.date.issued2002
 
dc.description.abstractWe assessed the spectrum of airway disorders in children with congenital cardiac anomalies, and reviewed our experience in using flexible bronchoscopy for assessment of airway problems in this patient group. The clinical records, flexible bronchoscopic findings, and cardiac imaging results of pediatric cardiac patients who presented with either clinical or radiological signs of airway obstruction between 1992-1999 were reviewed. Frexible bronchoscopic assessment was performed with the patients under sedation and topical anesthesia, using one of two bronchoscopes, i.e., an Olympus BFN20 or Olympus BF3C20. Of a total of 52 patients, 33 had acyanotic cardiovascular lesions, the commonest being left-to-right shunts (61%), while 19 had cyanotic heart lesions, with right ventricular outflow obstruction being the commonest (63%). Twenty-seven patients had undergone either surgical or transcatheter interventions. The median age at bronchoscopic assessment was 6 months (range, 4 days to 6 years). None of the patients developed significant procedural complications. A definitive diagnosis was made in 48 (92%) patients, 8 of whom had abnormalities involving only the upper airways, 35 only the lower airways, and 5 both. Abnormalities of the upper airway included laryngomalacia (n = 6), subglottic stenosis (n = 3), pharyngeal collapse (n = 2), and 1 each of choanal stenosis and supraglottitis. Extrinsic compression was the commonest lower airway abnormality that was found in 27/40 patients (67%), with a predilection for the left main bronchus (18/27, 67%). The structures that caused extrinsic compression included dilated pulmonary arteries with or without left atrial dilation (n = 20), an anomalous aortic or pulmonary arterial course (n = 3), a dilated aorta (n = 1), and a shunt (n = 1), but were not obvious in 2 patients. Intrinsic lower airway abnormalities included bronchomalacia (n = 4), tracheal stenosis (n = 4), and one each of variant bronchial bifurcation and a pouch arising from the tracheal wall. Intraluminal mucus plugging of the lower airways occurred in the remaining 3 patients. Children with congenital heart disease are at risk of airway obstruction both before and after surgery. Flexible bronchoscopy, being safe and effective in diagnosing airway disorders in this patient group, should be considered as the first line of investigation. © 2002 Wiley-Liss, Inc.
 
dc.description.naturelink_to_subscribed_fulltext
 
dc.identifier.citationPediatric Pulmonology, 2002, v. 34 n. 4, p. 304-311 [How to Cite?]
DOI: http://dx.doi.org/10.1002/ppul.10164
 
dc.identifier.doihttp://dx.doi.org/10.1002/ppul.10164
 
dc.identifier.epage311
 
dc.identifier.isiWOS:000178269800008
 
dc.identifier.issn8755-6863
2013 Impact Factor: 2.297
2013 SCImago Journal Rankings: 1.092
 
dc.identifier.issue4
 
dc.identifier.pmid12205572
 
dc.identifier.scopuseid_2-s2.0-0036784990
 
dc.identifier.spage304
 
dc.identifier.urihttp://hdl.handle.net/10722/170320
 
dc.identifier.volume34
 
dc.languageeng
 
dc.publisherJohn Wiley & Sons, Inc. The Journal's web site is located at http://www3.interscience.wiley.com/cgi-bin/jhome/39249
 
dc.publisher.placeUnited States
 
dc.relation.ispartofPediatric Pulmonology
 
dc.relation.referencesReferences in Scopus
 
dc.subject.meshAirway Obstruction - Complications - Diagnosis
 
dc.subject.meshBronchoscopy - Methods
 
dc.subject.meshChild
 
dc.subject.meshChild, Preschool
 
dc.subject.meshFemale
 
dc.subject.meshHeart Defects, Congenital - Complications
 
dc.subject.meshHumans
 
dc.subject.meshInfant
 
dc.subject.meshInfant, Newborn
 
dc.subject.meshMale
 
dc.subject.meshRespiratory System Abnormalities - Diagnosis
 
dc.titleAirway obstruction in children with congenital heart disease: Assessment by flexible bronchoscopy
 
dc.typeArticle
 
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Author Affiliations
  1. The University of Hong Kong
  2. Queen Mary Hospital Hong Kong