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Stenting of the mainstem bronchus in children: a word of caution

Winfield J Wells1, Namath S Hussain, John C Wood

  • 1Division of Cardiothoracic Surgery, Keck School of Medicine, University of Southern California and Childrens Hospital Los Angeles, Los Angeles, California 90027, USA.

The Annals of Thoracic Surgery
|April 6, 2004
PubMed

Insights

Expandable metallic stents in pediatric mainstem bronchus can cause life-threatening bleeding due to erosion into arteries. Careful consideration is crucial, especially for cyanotic children, due to risks of pseudoaneurysm and hemorrhage.

Area of Science:

  • Pediatric Pulmonology
  • Interventional Pulmonology
  • Medical Device Complications

Background:

  • Expandable metallic stenting is used for pediatric airway obstruction.
  • Left mainstem bronchus stenting presents unique challenges in pediatric patients.

Observation:

  • Two pediatric patients experienced critical hemorrhage after left mainstem bronchus stenting.
  • Stent migration led to erosion into a bronchial artery in both cases.

Findings:

  • Mycotic pseudoaneurysm formation and severe pulmonary hemorrhage were observed.
  • One patient succumbed to hemoptysis; the other required left pneumonectomy and aortic repair.

Implications:

  • Stenting the mainstem bronchus in children, particularly those with cyanotic heart disease, carries significant risks.
  • Extreme caution and careful patient selection are necessary for this procedure.

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