Bronchial Stenting in Infants with Severe Bronchomalacia: Technique and Outcomes
Presenter
Niki Mittal, BS, The University of California, San Diego, San Diego, CA
Niki Mittal, BS1, Howaida El-Said, M.D., Ph.D., FSCAI1, Kanishka Ratnayaka, MD2, Aparna Rao, MD1, Tzyynong L. Friesen, MD1 and Matthew T Brigger, MD1, (1)The University of California, San Diego, San Diego, CA, (2)-, San Diego, CA
Keywords: Congenital Heart Disease (CHD)
Background:
Infant bronchomalacia often requires prolonged mechanical ventilation and can be life-threatening. Effective treatment for severe infant bronchomalacia continues to be elusive. We present bronchial stenting for no-option or treatment refractory infant bronchomalacia. We report the first use of a balloon expandable Integrity bare metal stent for treating infant bronchomalacia.
Methods:
Three consecutive cases of stenting to relieve conservative treatment refractory severe infant bronchomalacia were performed between 2/2019-12/2020. Initial diagnosis was confirmed with 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.
Results:
Our initial clinical experience with our bare metal stent of choice (Integrity, Medtronic, Minneapolis, MN) 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.
Conclusions:
In cases of severe bronchomalacia in the infant population, bronchial stenting with the bare metal coronary stent has been effective in relieving bronchial stenosis with no complications. 