Nadir Görülen Bronş Basısı Nedeni: Hafif Pulmoner Hipertansiyon

Year 2019, , 391 - 394, 23.09.2019

Şahin Sincar

https://doi.org/10.12956/tchd.562719

Abstract

Atriyal septal defekt  (ASD) ve ventriküler septal defekt (VSD) en sık görülen konjenital kalp anomalileridir. Bu olgu sunumunda ASD ve VSD’ye ikincil gelişen hafif pulmoner arteryel hipertansiyonla (PAH) birlikte seyreden, solunum ve böbrek yetmezliği nedeniyle entübe edilmiş olan altı aylık kız hasta takdim edilmiştir. Ekstübasyon başarısızlığına neden olan sol total atelektazinin sık tekrar etmesi nedeniyle hasta bronş basısı açısından incelendiğinde sağ pulmoner arterin (PA) sol ana bronşa kompresyonu tespit edilmiştir. Aynı seansta ASD ve VSD’nin de kapatıldığı operasyonda sağ PA çıkan aort önüne askıya alınarak bası giderilmiştir. Ameliyat sonrası başarılı bir şekilde ekstübe edilen hasta şifa ile taburcu edilmiştir. Özellikle konjenital kalp hastalığı olan ve aynı lokalizasyonda ortaya çıkan, tekrar eden pulmoner atelektazi olgularında bronş basısı öncelikle düşünülmesi gereken etiyolojilerden birisidir. 

Keywords

Atelektazi, Bronş, Bası

A Rare Cause of Bronchial Compression: Mild Pulmonary Hypertension

Abstract

Atrial septal defect (ASD) and ventricular septal defect (VSD) are the most common congenital heart anomalies. In this case report, a six-month-old girl with mild pulmonary arterial hypertension (PAH) secondary to ASD and VSD was presented. The patient was admitted due to respiratory failure and renal insufficiency. Evaluation for recurrent extubation failures secondary to left total atelectasis yielded right pulmonary arterial (PA) compression to the left main bronchus. Compression was relieved with right pulmonary arteriopexy with ASD and VSD closure in the same session. The patient was extubated successfully in the immediate postoperative period and eventually discharged home. Bronchial compression should be considered especially in patients with congenital heart disease and recurrent cases of atelectasis in the same location.

Keywords

Atelectasis, Bronchial, Compression

References

• 1-Wallis C, McLaren CA. Tracheobronchial stenting for airway malacia. Paediatr Respir Rev 2018;27:48-59.
• 2-Talwar S, Sharma P, Choudhary SK, Kothari SS, Gulati GS, Airan B. Le-Compte’s maneuver for relief of bronchial compression in atrial septal defect. J Card Surg 2011;26:111-3.
• 3- Eugene Blackstone, Frank Hanley, James Kirklin, Nicholas Kouchoukos. Atrial septal defect and partial anomalous pulmonary venous connection. Kirklin Barratt Boyes Cardiac Surgery. Elsevier Saunders; 4nd ed. Philadelphia 2013:1156.
• 4-Kussman BD, Geva T, Mcgowan FX Jr. Cardiovascular causes of airway compression. Pediatr Anesth 2004;14: 60-74.
• 5-Eyüboğlu TŞ, Aslan AT, Öztunalı Ç, Tunaoğlu S, Oğuz AD, Kula S, et. al Unknown vascular compression of the airway in patients with congenital heart disease and persistent lower respiratory symptoms, Turk J Med Sci 2017;13:1384-92
• 6-Berlinger NT, Long C, Foker J, Lucas RV Jr. Tracheobronchial compression in acyanotic congenital heart disease. Ann Otol Rhinol Laryngol 1983;92:387-90.
• 7- Stanger P, Lucas RV Jr, Edwards JE. Anatomic factors causing respiratory distress in acyanotic congenital cardiac disease. Special reference to bronchial obstruction. Pediatrics 1969;43:760-9.
• 8-Kulik TJ .Department of Cardiology, Division of Cardiac Critical Care, and the Pulmonary Hypertension Program, Children’s Hospital Boston, Boston, Massachusetts, USA. Pulm Circ 2012;2:327.
• 9- Hraska V, Photiadis J, Schindler E, Sinzobahamvya N,Fink C,Haun C, et al. A novel approach to the repair of tetralogy of Fallot with absent pulmonary valve and the reduction of airway compression by the pulmonary artery. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2009;12:59-62.
• 10- Nomura N, Asano M, Mizuno A, Mishima A. Translocation of dilated pulmonary artery for relief of bronchial compression associated with ventricular septal defect. Eur J Cardiothorac Surg 2007;32:937-9.
• 11-Zopf DA, Hollister SJ, Nelson ME, Ohye RG, Green GE. Bioresorbable Airway Splint Created with a Three-Dimensional Printer. N Engl J Med 2013;21:2043-5.