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Plastic Bronchitis-A Serious Rare Complication Affecting Children Only after Fontan Procedure?
Ilona Pałyga-Bysiecka1,2, Aneta Maria Polewczyk1,2, Maciej Polewczyk2
1First Department of Pediatrics, Swietokrzyskie Pediatric Center, 25-736 Kielce, Poland.
Journal of Clinical Medicine
|January 11, 2022
Summary
Plastic bronchitis (PB) in children can occur with or without congenital heart disease (CHD). While treatments exist, recurrences are common, with differences in age of onset and cast location between CHD and non-CHD patients.
Area of Science:
- Pediatric Pulmonology
- Pediatric Cardiology
- Critical Care Medicine
Background:
- Plastic bronchitis (PB) is a rare but serious condition affecting children, presenting both in those with congenital heart disease (CHD) and those without cardiac anomalies.
- Understanding the distinct clinical courses and treatment outcomes for PB in these two pediatric populations is crucial for effective management.
Purpose of the Study:
- To compare the clinical presentation, therapeutic interventions, and outcomes of plastic bronchitis in children with CHD (post-Fontan procedure) versus children without heart defects.
- To identify differences in disease recurrence, age of onset, and bronchial cast characteristics between the two groups.
Main Methods:
- A retrospective case series involving children diagnosed with PB between 2015 and 2019.
- Data collection included patient records and follow-up contact via email or telephone to assess recurrence and treatment strategies.
- Diagnosis was confirmed by the expectoration of endobronchial plugs, either spontaneously or during bronchoscopy.
Main Results:
- Symptoms of PB included cough, dyspnea, hypoxemia, and potential acute respiratory failure in both groups.
- Children with CHD experienced their first PB episode at a younger age compared to non-CHD children.
- Recurrences were observed in both groups despite inhaled therapy, with a longer mean recurrence time in the CHD group (1.47 years vs. 0.265 years).
- Bronchial casts were predominantly on the right side in CHD patients and on the left side in non-CHD patients.
Conclusions:
- While PB shares similarities across pediatric groups, distinct features exist in non-CHD patients, including later onset, left-sided cast location, and potentially a greater role for inflammatory mechanisms.
- Further research is warranted to elucidate the pathophysiology of PB and optimize therapeutic approaches for affected children.
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