用球囊可膨胀裸金属冠状动脉支架治疗婴儿严重左主干支气管软化1例

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports Pub Date : 2025-06-12 DOI:10.1016/j.epsc.2025.103042

Efua H. Bolouvi , Michael D. Seckeler , Angelina Price , Wayne Morgan , Brian Lightwine , Kenneth W. Liechty

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引用次数: 0

摘要

婴儿支气管软化症的治疗是一项重大挑战。手术策略，如主动脉固定术和气管固定术在远端气道疾病有不同的结果。在特定情况下，支架置入术通常作为最后的手段。一个4个月前34周的婴儿状态-新生儿修复大脐膨出术后6周因严重呼吸窘迫再次插管。尽管呼气末正压、支气管扩张剂和气道清除率不断升高，但呼吸功能继续下降。支气管镜检查显示严重的左主支气管软化和支气管狭窄，胸部计算机断层扫描（CT）证实。左主支气管几乎完全闭塞，但远端气道通畅。在透视和支气管镜引导下，将4.5 mm × 15 mm裸金属冠状动脉支架（Resolute Onyx Frontier）置入左主支气管。这导致肺力学立即改善，随后拔管。11周后选择性取出支架。然而，由于气道压迫，在24小时内再次发生闭塞，通过放置第二个支架（5mm × 15mm）来处理。症状完全消失，患者10个月时出院。他随后在另一家医院接受治疗。14个月大时取出支架。术后不久，患者再次出现左肺萎陷和呼吸道感染，需要体外膜氧合（ECMO）。然后放置一个8 mm × 20 mm的支架来招募左肺并允许ECMO脱管。他的支架还在。结论裸金属冠状动脉支架似乎是一种有效的临时管理选择，对于患有严重支气管软化症的婴儿来说，标准的非手术措施失败，使气道有时间变得更加僵硬。

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Management of severe left main bronchomalacia in an infant with a balloon expandable bare metal coronary stent: a case report

Introduction

Managing bronchomalacia in infants represents a significant challenge. Surgical strategies such as aortopexy and tracheopexy have variable outcomes in distal airway disease. Stent placement is typically reserved as a last resort in selected cases.

Case presentation

A 4-month-old ex-34-weeker infant status-post neonatal repair of a large omphalocele was re-intubated six weeks post-operatively for severe respiratory distress. Despite escalating positive-end expiratory pressure, bronchodilators, and airway clearance, the respiratory function continued to decline. Bronchoscopy showed severe left main bronchomalacia and bronchial stenosis, confirmed by chest computerized tomography (CT). There was near complete occlusion of the left main bronchus, but with patent distal airway. A 4.5 mm × 15 mm bare metal coronary stent (Resolute Onyx Frontier) was placed in the left main bronchus under fluoroscopic and bronchoscopic guidance. This led to an immediate improvement in lung mechanics, with subsequent extubation. The stent was electively removed after 11 weeks. However, re-occlusion occurred within 24 hours due to airway compression, which was managed with the placement of a second stent (5 mm × 15 mm). The symptoms resolved completely, and the patient was discharged home at the age of 10 months. He was subsequently managed at a different hospital. At the age of 14 months the stent was removed. Shortly after the removal, he had a recurrence of the left lung collapse and a respiratory infection requiring extracorporeal membrane oxygenation (ECMO). An 8 mm × 20 mm stent was then placed to recruit the left lung and allow ECMO decannulation. He remains with the stent in place.

Conclusion

Bare metal coronary stents appear to be an effective temporizing management option for infants with severe bronchomalacia who fail standard non-operative measures, allowing time for the airway to become more rigid.

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