Rationale: Tracheomalacia, typically seen in relapsing polychondritis, 1 is rarely reported in association with congenital heart disease (CHD). In patients with pulmonary hypoperfusion-type CHD, surgical repair results in a rapid increase in pulmonary blood flow, predisposing them to mucus retention, airway obstruction, and respiratory distress. We describe acute airway collapse in a patient with double outlet right ventricle and congenital bronchial stenosis following cardiac repair. Surgically augmented pulmonary flow critically narrowed the stenotic airway, rapidly reversed by bronchoscopic stenting. We introduce the concept of “hemodynamic-aggravated airway compromise” and advocate for protocolized monitoring in CHD-airway comorbidity cases. Patient concerns: A 19-year-old male with double outlet right ventricle and pulmonary stenosis underwent a central aortopulmonary shunt. Asymptomatic left main bronchial stenosis was incidentally found on preoperative CT. Four hours post-extubation, he developed acute respiratory distress. A bronchial stent was placed on postoperative day 10, resulting in marked clinical improvement and eventual discharge. Diagnoses: Stenosis of the left main bronchus and left upper lobe bronchus was noted on preoperative chest CT. Postoperative increases in pulmonary blood flow and mucus retention were thought to contribute to secondary airway obstruction. Bronchoscopy demonstrated significant luminal obstruction of the bronchus. Interventions: An airway stent was successfully deployed in the left main bronchus under bronchoscopic guidance. The patient recovered with comprehensive management including airway care, antimicrobial therapy, and inotropic support. Outcomes: Spontaneous breathing resumed on postoperative day 4 following stent placement; decannulation occurred day 10, and multidisciplinary discharge occurred on day 18 with stable cardiopulmonary status. Lessons: In patients who experience postoperative failure to liberate from mechanical ventilation accompanied by recurrent mucus retention, the possibility of underlying structural airway abnormalities should be carefully considered. Early evaluation with bronchoscopy and cross-sectional airway imaging is warranted for timely and accurate diagnosis. Once the anatomic obstruction is confirmed, bronchial stent placement represents a feasible, effective, and controllable therapeutic strategy. Rigorous pre-procedural assessment of indications and vigilant postoperative surveillance are essential to minimize the risk of stent-related complications.
Qin et al. (Fri,) studied this question.