Division of Pediatric Cardiology, Rady Children's Hospital and UC San Diego School of Medicine, 3020, Children's Way, San Diego, CA, USA.
Division of Pediatric Pulmonology, Rady Children's Hospital and UC San Diego School of Medicine, 3020, Children's Way, San Diego, CA, USA.
Int J Pediatr Otorhinolaryngol. 2021 Jun;145:110703. doi: 10.1016/j.ijporl.2021.110703. Epub 2021 Apr 6.
To report the first use of a balloon expandable bare metal stent for treating infant bronchomalacia.
Infant bronchomalacia often requires prolonged mechanical ventilation and can be life-threatening. Effective treatment for severe infant bronchomalacia continues to be elusive. We present three cases of bronchial stenting for no-option or treatment refractory infant bronchomalacia.
Three consecutive cases of stenting to relieve conservative treatment refractory severe infant bronchomalacia were performed between February 2019 and December 2020. Initial diagnosis was confirmed with Computed Tomography (CT) angiography. Patients underwent rigid micro laryngoscopy, bronchoscopy, and flexible bronchoscopy to evaluate the airway. Initial conservative management strategies were pursued. Patients failing initial conservative management strategies were considered for rescue bronchial stenting.
Our initial clinical experience with a coronary bare metal stent for these procedures has been favorable. The stent was easy to deploy with precision. We did not encounter stent embolization or migration. There was sufficient stent radial strength to relieve bronchomalacia without causing restenosis or erosion. There was no significant granulation tissue formation. In one patient, the stent was removed after 12 months of somatic growth; this was uneventful and bronchial patency was maintained. There were no complications in any of our patients regarding stent placement and reliability.
In cases of three infants with severe bronchomalacia, we found that bronchial stenting with the bare metal coronary stent was effective in relieving bronchial stenosis.
报告首例应用球囊扩张式金属裸支架治疗婴儿支气管软化症。
婴儿支气管软化症常需长时间机械通气，危及生命。严重婴儿支气管软化症的有效治疗方法仍难以捉摸。我们介绍了 3 例因无其他选择或治疗无效而行支气管支架置入术的婴儿支气管软化症病例。
2019 年 2 月至 2020 年 12 月，连续 3 例因保守治疗无效的严重婴儿支气管软化症而行支架置入术。最初的诊断通过 CT 血管造影得到证实。患者行硬性微喉镜、支气管镜和软性支气管镜检查以评估气道。最初采用保守治疗策略。对最初的保守治疗策略失败的患者考虑进行挽救性支气管支架置入。
我们在这些手术中使用冠状动脉金属裸支架的初步临床经验是良好的。支架易于精确部署。我们没有遇到支架栓塞或迁移。支架具有足够的径向强度来缓解支气管软化症，而不会导致再狭窄或侵蚀。没有明显的肉芽组织形成。在 1 例患者中，随着体生长 12 个月后取出支架，过程顺利，支气管保持通畅。在支架放置和可靠性方面，我们的患者均无并发症。
在 3 例严重支气管软化症婴儿中，我们发现金属裸冠状动脉支架置入术对缓解支气管狭窄有效。
