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Journal of Case Reports
Closure of Post-pneumonectomy Bronchial Stump Dehiscence using Amplatzer Device
Asma Navasakulpong1, Supaporn Roymanee2
1Division of Respiratory and Respiratory Critical Care Medicine, Faculty of Medicine; 2Pediatric Cardiology unit, Department of Pediatrics; Prince of Songkla University, Hatyai, Songkhla, 90110, Thailand.
Corresponding Author:
Dr. Asma Navasakulpong
Email: navasakulpong@hotmail.com
Received: 03-JAN-2018 Accepted: 01-MAR-2019 Published Online: 10-MAR-2019
DOI: http://dx.doi.org/10.17659/01.2019.0013
Background: Post-pneumonectomy bronchopleural fistulas (BPFs) or main bronchial stump dehiscence is complication with a high rate of morbidity and mortality. The patients may have limited performance status for reoperation. The authors have used a minimally invasive method with Amplatzer vascular plug II (AVP II), device that was originally designed for the trans-catheter closure of vascular structures or atrial septal defect, for main bronchial stump dehiscence closure. Case Report: A 61 year-old male patient with metastasis renal cell carcinoma, who had right main bronchial stump dehiscence from right pneumonectomy, was treated under general anesthesia (GA) by bronchoscopic closure of stump dehiscence using AVP II. After locating the stump dehiscence lesion under flexible bronchoscopic visualization, the first self-expanding nitinol made AVP II occluder No. 16 was delivered under bronchoscopic guidance over a delivery cable into the middle hole of fistulas. The second AVP II occluder No.8 was placed to the residual fistula later, using the same technique. The chest x-ray showed the decrement of pneumothorax in two months.  Conclusion: Endobronchial closure using the AVP II is a minimally invasive procedure which is safe and effective for treatment of main bronchial stump dehiscence. It is easily placed by using flexible bronchoscopy under GA or moderate conscious sedation.
Keywords : Bronchial Fistula, Bronchoscopy, Nitinol, Pneumonectomy, Pneumothorax, Renal Cell Carcinoma.
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