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VOLUME 24 , ISSUE 5 ( May, 2020 ) > List of Articles

Pediatric Critical Care

Flexible Fiber-optic Bronchoscopy-directed Interventions in Children with Congenital Heart Diseases

Ritika Chhawchharia, Raja Joshi, Neeraj Agarwal

Keywords : Airway anomalies, Bronchoalveolar lavage, Congenital heart disease, Flexible fiber-optic bronchoscopy, Interventions, Pediatric intensive care

Citation Information : Chhawchharia R, Joshi R, Agarwal N. Flexible Fiber-optic Bronchoscopy-directed Interventions in Children with Congenital Heart Diseases. Indian J Crit Care Med 2020; 24 (5):340-343.

DOI: 10.5005/jp-journals-10071-23419

License: CC BY-NC 4.0

Published Online: 28-07-2020

Copyright Statement:  Copyright © 2020; The Author(s).


Objective: In children, pulmonary and cardiac diseases are closely associated, and their integrated evaluation is important. Flexible fiber-optic bronchoscopy (FFB) can be used for both diagnostic and therapeutic purposes in pediatric cardiac intensive care units (PCICU). The objective of this study was to evaluate the utility of FFB in children with congenital heart disease (CHD). Materials and methods: A retrospective, descriptive study was conducted at a tertiary care center in pediatric patients who underwent FFB in PCICU over a period of 6 years (2012–2017). Results: Total 71 bronchoscopies were done in 58 patients with CHD with median age and weight of 2.5 months and 3.4 kg, respectively. Total of 20 different cardiac lesions were present among patients who underwent FFB. While 38 (53.5%) and 30 (42.3%) procedures were performed in pre-op and postoperative patients, respectively, 3 intraoperative bronchoscopies were also performed. The main indications for FFB were persistent atelectasis (42/71), prolonged oxygen requirement (13/71), stridor (8/71), and suspected airway anomaly (6/71). Tracheobronchitis was the commonest bronchoscopy finding (51/71, 71.8%) followed by tracheobronchomalacia (27/71, 38.3%). Cause of stridor detected in 7/8 cases. Associated preoperative and postoperative respiratory complications were detected and necessary interventions were done. These included slide tracheoplasty (5/58), tracheostomy (5/58), antibiotic change based on bronchoalveolar lavage (BAL) cultures (11/71), and continued positive pressure ventilation (4/71). Nonconsequential complications were transient hypoxemia (10/71), bleeding (2/71), and transient bradycardia (1/71). Conclusion: Bedside FFB is a safe and a valuable diagnostic tool that also helps in guiding interventions in children with cardiac diseases.

  1. Lee SL, Cheung YF, Leung MP, Ng YK, Tsoi NS. Airway obstruction in children with congenital heart disease: assessment by flexible bronchoscopy. Pediatr Pulmonol 2002;34(4):304–311. DOI: 10.1002/ppul.10164.
  2. Chapotte C, Monrigal JP, Pezard P, Jeudy C, Subayi JB, De Brux JL, et al. Airway compression in children due to congenital heart disease: value of flexible fiberoptic bronchoscopic assessment. J Cardiothorac Vasc Anesth 1998;12:145–152. DOI: 10.1016/S1053-0770(98) 90321-4.
  3. Kockar T, Gunduz M, Oktem S, Gundogdu S, Demirel FG, Tastekin A, et al. Bronchoscopic findings in children with congenital heart diseases. European Respirat J 2015;46(S59):PA1355. DOI: 10.1183/13993003.congress-2015.PA1355.
  4. Robotin M, Bruniaux J, Serraf A, Uva MS, Roussin R, Lacour-Gayet F, et al. Unusual forms of tracheobronchial compression in infants with congenital heart disease. J Thorac Cardiovasc 1996;112(2):415–423. DOI: 10.1016/S0022-5223(96)70269-6.
  5. Cerda J, Chacón J, Reichhard C, Bertrand P, Holmgren NL, Clavería C, et al. Flexible fiberoptic bronchoscopy in children with heart diseases: a twelve years experience. Pediatr Pulmonol 2007;42(4):319–324. DOI: 10.1002/ppul.20577.
  6. Godfrey S, Avital A, Maayan C, Rotschild M, Springer C. Yield from flexible bronchoscopy in children. Pediatr Pulmonol 1997;23(4):261–269. DOI: 10.1002/(SICI)1099-0496(199704)23:4<261::AID-PPUL3>3.0.CO;2-P.
  7. Nussbaum E. Pediatric fiberoptic bronchoscopy: clinical experience with 2,836 bronchoscopies. Pediatr Crit Care Med 2002;3:171–176. DOI: 10.1097/00130478-200204000-00015.
  8. Corno A, Giamberti A, Giannico S, Marino B, Rossi E, Marcelletti C, et al. Airway obstructions associated with congenital heart disease in infancy. J Thorac Cardiovasc Surg 1990;99(6):1091–1098.
  9. Corno A, Picardo S, Ballerini L, Gugliantini P, Marcellett C. Bronchial compression by dilated pulmonary artery. Surgical treatment. J Thorac Cardiovasc Surg 1985;90(5):706–710. DOI: 10.1016/S0022-5223(19)38538-1.
  10. Yamaguchi D, Tanigami H, Suematsu Y, Murakami A, Kitsuta Y, Ishii T, et al. Airway obstruction in children due to congenital heart disease (our 15 years experience). Jpn J Trauma Emerg Med 2012;3(1): 17–24.
  11. Wood RE. The emerging role of flexible bronchoscopy in pediatrics. Clin Chest Med 2001;22(2):311–317. DOI: 10.1016/S0272-5231(05)70045-9.
  12. Fonseca MT, Camargos PA, AbouTaam R, Le Bourgeois M, Scheinmann P, de Blic J. Incidence rate and factors related to post-bronchoalveolar lavage fever in children. Respiration 2007;74(6):653–658. DOI: 10.1159/000107737.
  13. Bar-Zohar D, Sivan Y. The yield of flexible fiberoptic bronchoscopy in pediatric intensive care patients. Chest 2004;126(4):1353–1359. DOI: 10.1378/chest.126.4.1353.
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