Stent Placement and Coil Embolization for Plastic Bronchitis in a Patient With Hypoplastic Left Heart Syndrome

Plastic bronchitis is a severe complication following the Fontan procedure, characterized by the formation of tracheal casts, leading to respiratory failure. No established treatment exists for post-surgical plastic bronchitis. We present the case of a three-year-old boy with hypoplastic left heart syndrome who developed plastic bronchitis two years after the Fontan procedure. Despite initial treatments, his condition did not improve until catheterization was performed to place a stent in the left pulmonary artery and embolize aortopulmonary collateral vessels. This combined approach resulted in significant clinical improvement and no recurrence until 17 months. Elevated pulmonary venous pressure can lead to increased mucin secretion from the tracheal epithelium; reducing this pressure may be effective for treating plastic bronchitis. Our case demonstrates the successful application of simultaneous stenting and coil embolization, resulting in a rapid decrease in pulmonary venous pressure and an improvement in the patient's condition. This combined approach may offer a promising therapeutic option for managing plastic bronchitis after the Fontan procedure.