P.261 Relieving bronchial compression due to cardiomegaly; the role of aortopexy when LVAD support just isn’t enough
Sunday May 05, 2019 from 18:30 to 19:30
Exhibit-Poster Area
Presenter

Jessica A Laks, Canada

Clinical Fellow

Cardiology

The Hospital for Sick Children

Abstract

Relieving bronchial compression due to cardiomegaly; the role of aortopexy when LVAD support just isn’t enough

Jessica Laks1, Maruti Haranal4, Patricia Purcell2, Sharon L. Cushing2, Mjaye Mazwi3, Osami Honjo4, Aamir Jeewa1.

1Cardiology, The Hospital for Sick Children, Toronto, ON, Canada; 2Otolaryngology, The Hospital for Sick Children, Toronto, ON, Canada; 3Critical Care, The Hospital for Sick Children, Toronto, ON, Canada; 4Cardiovascular Surgery, The Hospital for Sick Children, Toronto, ON, Canada

Introduction: Pediatric ventricular assist devices (VADs) are standard of care for bridging patients to heart transplant. Bronchial compression due to cardiomegaly is seen in some patients with chronic heart failure, but is often relieved with cardiac decompression by the VAD. We present a case of aortopexy after VAD implant to relieve respiratory failure caused by refractory left main bronchus compression in the context of cardiomegaly.

Case Report: One year old male with cardiomyopathy developed left lung collapse due to bronchial compression from cardiomegaly. After failed attempt at expansion with positive pressure ventilation and worsening heart failure, he underwent left VAD implantation. However, lung collapse and respiratory failure persisted despite optimized VAD support. Bronchoscopy and computed tomography demonstrated focal extrinsic compression of the left main bronchus immediately below the level of the carina secondary to compression between the right pulmonary artery and descending aorta. Decision was made to proceed with anterior aortopexy. Bronchoscopy after induction showed complete occlusion of left main bronchus. The chest was reopened and ascending aorta was exposed. Two 3-0 pledgetted polypropylene sutures were used to pull the ascending aorta anterolaterally. Gortex membrane was used to wrap the outflow cannula. Following chest closure, suspension sutures were fixed on the sternum under bronchoscopic guidance to ensure that left main bronchus patency was maintained. At the end of the procedure the left main bronchus was 50% compared to being 100% occluded at baseline.  The functional benefit achieved by the increased patency contributed to successful extubation 6 days post aortopexy.

Summary:  Respiratory failure caused by left main bronchial compression due to cardiomegaly is a known complication of heart failure. Decompression often improves this condition; though in this case was not effective despite optimized VAD support. We highlight a case in which aortopexy, was feasible and successful in relieving compression of left main bronchus post VAD implantation.


Lectures by Jessica A Laks


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