Perioperative Bronchoscopy in Children with Congenital Heart Disease of the Developing World
2Pediatric Pulmonology Unit, Pediatric Pulmonology Unit, Wolfson Medical Center, Holon, Israel, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel, ישראל
3Pediatric Cardiology, Department of Pediatric Cardiology, Wolfson Medical Center, Holon, Israel, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel., ישראל
4Cardiothoracic Surgery, Department of Cardiothoracic Surgery, Wolfson Medical Center, Holon, Israel, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel, ישראל
Objectives: To study the clinical characteristics and impact of bronchoscopy in the previously unexplored children population from developing countries, referred for cardiac surgery, through "Save a Child`s Heart" (SACH) organization.
Methods: We performed a retrospective hospital-chart review concerning these SACH`s children (0-18 years-old) during 2006-2021. We examined demographics, type of congenital-heart-disease (CHD), indications, findings, subsequent recommendations, ventilation days and intensive-care-unit stay. The primary outcomes were, percent managements and diagnostics changes, based on the bronchoscopic findings. We included a control group matched-for-age and CHD type, who did not undergo bronchoscopy, and compared the clinical characteristics` to the bronchoscopy group.
Results: We included 82 bronchoscopies in 68 children, 18 (26.4%), 46 (67.6%) and 4 (5.8%) children, pre-operatively, post-operatively, or both, respectively. The most prevalent CHD were Tetralogy-of-Fallot (27.9%) and ventricular-septal-defect (19.1%). The main indications were persistent atelectasis (41%), followed by mechanical ventilation/weaning difficulties (27.9%). Bronchoscopic evaluations revealed at least one abnormality in 51/68 (75%) children. The most common findings were external airway compression (23.5%), bronchomalacia (19.1%) and mucus secretions (14.7%). In 35 (51.4%) cases, we changed our management based on the bronchoscopies findings, of those, a major change ensued in 14 children. When compared to the control group, the bronchoscopic children were both ventilated (median 6 vs 1.5 days, p<0.0001) and stayed longer at the PICU (median 1.5 vs 18.5 days, p<0.0001).
Conclusion: Bronchoscopy may be an important tool in the diagnosis and management of the unique group of children from developing countries with CHD referred for cardiac surgery. In our study, we demonstrated a more complicated course in children requiring bronchoscopy compared to controls.