Amplatzer Device in Bronchial Stump Fistula after Extrapleural Pneumonectomy

Our plain-English summary of Amplatzer Device in Bronchial Stump Fistula after Extrapleural Pneumonectomy, by J. Turtiainen, J.V. Räsänen, S. Hiippala, et al (The Thoracic and Cardiovascular Surgeon, 2016).

The study

• Authors: J. Turtiainen, J.V. Räsänen, S. Hiippala, E. Tukiainen, J.A. Salo
• Journal: The Thoracic and Cardiovascular Surgeon
• Published: 2016;64(6):540-2
• Type of article: Case report
• Read it: PubMed · Publisher

Abstract

Endoscopically superimposed Amplatzer (St. Jude Medical, St. Paul, Minnesota, United States) septal occluder plug was successfully used in the treatment of septic right main bronchus fistula having developed after extrapleural pneumonectomy and heated chemotherapy in two patients with malignant pleural mesothelioma. In the first case the method was curative and in the other Amplatzer served as temporary bridging allowing rehabilitation from empyema and sepsis. After 4.5 and 4.2 years both patients are alive with no sign of relapse of mesothelioma or infection.

Georg Thieme Verlag KG Stuttgart · New York.

In plain English

This article is a case report of two patients treated at Helsinki University Central Hospital, Finland. Both were men with malignant epithelial pleural mesothelioma who had extrapleural pneumonectomy, followed by heated chemotherapy in the chest cavity. Both later developed sepsis, empyema and a fistula (an opening) in the stump of the right main bronchus. The first, a 25-year-old who had earlier had radiation therapy for Hodgkin lymphoma, had a 2 to 3 mm fistula closed through a bronchoscope with a 4 mm Amplatzer septal occluder, a device traditionally used by cardiologists to close heart septal defects. He was alive 53 months after diagnosis with no sign of relapse or infection. The second, a 69-year-old with a history of asbestosis, improved for 6 months after a 5 mm device. New fistulae then formed, and sepsis returned despite more devices. The devices and prostheses were removed and the defects covered with a vastus lateralis muscle flap. At 49 months after diagnosis he had no signs of relapse or infection. The authors concluded these devices may give permanent closure or a temporary bridge, especially for fistulae under 10 mm.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report of two patients
• Who was studied: Two men treated at Helsinki University Central Hospital, Finland: a 25-year-old and a 69-year-old. Both had malignant epithelial pleural mesothelioma treated with right extrapleural pneumonectomy and hyperthermic intracavitary chemotherapy, and both developed a right main bronchial stump fistula with sepsis and empyema.
• Exposure: The article studies a treatment, not an exposure: endoscopic closure of bronchial stump fistulae with Amplatzer septal occluder devices. It gives no asbestos exposure details. The second patient had a history of asbestosis. The first had received radiation therapy to the right chest and neck for Hodgkin lymphoma 13 years before mesothelioma developed.
• Main results:
  • Case 1: six months after extrapleural pneumonectomy the patient had sepsis, empyema and a bronchial stump fistula 2 to 3 mm in diameter. At bronchoscopy it was closed with a 4 mm Amplatzer device. The empyema was treated with thoracoscopic debridement and antibiotics.
  • Case 1: the patient remained alive 53 months after diagnosis of mesothelioma with no sign of relapse of disease or infection.
  • Case 2: admitted 10 months after surgery with empyema and a bronchial stump fistula. A 5 mm Amplatzer device led to improvement of sepsis and general condition for 6 months.
  • Case 2: two recurrent fistulae then developed. Sepsis recurred despite two further Amplatzer devices (10 and 20 mm), several thoracoscopic debridements and an open-window procedure. The devices and the diaphragmatic and pericardial prostheses were removed at thoracotomy, and the defects were covered with a free vastus lateralis musculocutaneous flap. After this, the fistulae and infection healed.
  • Case 2: 49 months after diagnosis of mesothelioma the patient had no signs of relapse of the disease or infection.
  • In the authors' unit, an average of five to six extrapleural pneumonectomies were performed per year over the previous 5 years, with two bronchial stump fistulae so far.
• The authors' conclusion: The authors concluded that bronchoscopically placed Amplatzer devices may offer either permanent closure of bronchopleural or bronchial stump fistulae, or serve as temporary bridges until the patient's condition improves, especially when the fistula is less than 10 mm.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Extrapleural Pneumonectomy (EPP), Bronchus, Chemotherapy, Pleural Mesothelioma, Empyema, Mesothelioma.

Related studies

• Use of the posterior pericardium to cover the bronchial stump after right extrapleural pneumonectomy — M. de Perrot (2013)
• Treatment of bronchial fistula after extraplural pneumonectomy using flexible bronchoscopy with the administration of OK432, fibroblast growth factor basic and fibrin glue sealant — N. Kondo, M. Hashimoto, et al. (2020)
• Transsternal transpericardial operations in the treatment of bronchopleural fistulas after pneumonectomy — G. Stamatis, G. Martini, et al. (1996)
• Single site venovenous extracorporeal membrane oxygenation as an alternative to invasive ventilation in post-pneumonectomy fistula with acute respiratory failure — M. Fica, F. Suárez, et al. (2012)
• Digital quantification of air leak to identify the location of an alveolopleural fistula — T.M. Saettele, C.A. Jimenez (2014)
• The role of muscle flap in preventing bronchus stump insufficiency after pneumonectomy for malignant pleural mesothelioma in high-risk patients — M. Beshay, G. Carboni, et al. (2008)

Browse more research in The Thoracic and Cardiovascular Surgeon, or return to medical research.