http://www.paper.edu.cnEmergencyTreatmentofEndobronchialStentsPlacementinSeriousMainBronchialStenosisFollowingHigh-riskOrthotopicHeartAllotransplantation1YongxiangZhao＊1,LinglingZhao1,BoYi1,ZhongguiShan2,QinmingFan2,MingyaoKe2,ChongxianLiao2,QifaYe1,ZufaHuang1,YueZhu31TheNationalMinistryofHealthTransplantationEngineeringandTechnicalReseachCenter,TheThirdXiangyaHospital,CentralSouthUniversity,Changsha,Hunan410013,PRChina2TheAffiliatedZhongshanHospital,XiamenUniversity,Xiamen,Fujian361003,PRChina3OrganTransplantationInstitute,UniversityofPittsburgh,200LothropStreetC-700,Pittsburgh,PA15213,USA*Correspondenceto:YongxiangZhao,MD,TheThirdXiangyaHospital,CentralSouthUniversity,Changsha,Hunan410013P.R.China,Tel:+867318618316,Fax:+86-8638327,Email:yongxiang_zhao@126.comAbstractObjective:Toinvestigatethecurativeeffectofemergencystentplacementforleftmainbronchialmalacia,stenosisandcollapseafterorthotopicheartallotransplantation.Methods:Toevaluatetheriskandefficacyoftreatmentofbronchusstentplacementafterorthotopicheartallotransplantationinonedilatedcardiomyopathypatientcomplicatedwithleftmainbronchialmalacia,stenosisandcollapseresultinginleftpulmonaryventilationdysfunction,andothermulti-diseases,suchasseverepulmonaryarteryhypertensionandmixed(mainlycentral)sleepapneasyndrome.Results:Aftertreatmentofstentplacement,patientwasrelievedfromleftpulmonaryventilationdysfunctionwithobviouslyimprovedhypercapnia,hypoxemia,pulmonaryhypertensionandthefunctionoftransplantingheartrecovered.Conclusions:Emergencytreatmentwithstentplacementforbronchialmalacia,stenosisandcollapseoccurringafterorthotopicheartallotransplantationcouldimproveventilationdysfunctioncausedbybronchialmalaciaandstenosis,andincreasethesurvivalrateofhearttransplantation.Keywords:orthotopiccardiactransplantation,bronchialmalacia,stenosis,stentplacementHearttransplantationisnowanestablishedtechniquefortheeffectivetreatmentofend-stageheartdiseases,includingdilatedcardiomyopathy,rheumaticheartdiseasesandischemicheartdiseases(1,2,3,4).Tracheobronchialobstructionfromeitherbenignormalignantdiseaseisassociatedwithhighmorbidityandpossibleearlydeathbyasphyxia1(5).Evenintheabsenceofparenchymallungdisease,ventilationfailurefrequentlyoccursiftheobstructionisnotrelieved(6).Avarietyofbenignetiologiescanunderlyairwayobstruction,includingtracheomalacia,trachealstricture,inflammatorydiseasessuchasWegener’sgranulomatosisandrelapsingpolychondritis,andanastomoticstricturefollowinglung1ThisworkwassupportedbycentralsouthuniversitykeysubjectprojectoftransplantationfoundationofChina.No2004-24。-1-http://www.paper.edu.cntransplantation(7).Centralairwayobstructioncanresultindyspnea,cough,andimpairedclearanceofrespiratorysecretions.Surgicaltrachealsleeveresectionandreconstructionremainsthe“goldstandard”treatmentformostbenignairwaystrictures.However,themanagementofpatientswithtracheobronchialstricturesofbenignetiologycanbequitechallenging(8).Therearealargenumberofpatientswithlesionsnotamenabletosurgery,orwhoareconsideredmedicallyinoperable(9).Endoscopicimplantationofairwayprostheses(stents)inthesepatientshasgainedincreasingpopularityoverthelastdecade.Uptillnow,itisdemonstratedthatstentinghasshownefficacyinsuchbenignairwayconditionssuchasrelapsingpolychondritis(10),tuberculosis(11)andpost-lungtransplantstenoses(12).Inthesepatients,airwaystentingmayrepre...
