Archivos de Bronconeumología (English Edition) Archivos de Bronconeumología (English Edition)
Arch Bronconeumol 2017;53:637 - Vol. 53 Num.11 DOI: 10.1016/j.arbr.2017.09.005
Clinical Image
Bronchopleural Fistula Management With Amplatzer™ Insertion
Manejo de fístula broncopleural mediante colocación del dispositivo Amplatzer®
Ana Isabel Triviño Ramíreza,, , Mercedes Merino Sánchezb, Cayo García Polob
a Servicio de Cirugía Torácica, Hospital Universitario Puerta del Mar, Cádiz, Spain
b Servicio de Neumología, Hospital Universitario Puerta del Mar, Cádiz, Spain

We report the case of a 66-year-old patient with the following history: right empyema on 2 occasions, atypical resection for invasive adenocarcinoma (1.5cm) in the left lower lobe, atypical resection for squamous cell carcinoma (2.5cm) in the right upper lobe (RUL) 4 months later, and decortication by thoracotomy.

Ten months after the last intervention, due to suspected RUL recurrence on suture site, right upper lobectomy with lymphadenectomy was completed.

During the early postoperative period, the patient presented dehiscence of the bronchial stump. Despite reintervention, fiberoptic bronchoscopy revealed persistent bronchopleural fistula (BPF) measuring 8×5mm in the RUL bronchial stump.

In view of the significant pleural thickening, the size of the BPF, and the small residual apical cavity, we decided to perform a thoracostomy.

After examining various therapeutic options, we opted to close the BPF with an Amplatzer® Septal-Occluder device, usually employed for foramen ovale closure.1,2

The procedure was performed under sedation in the operating room. The 10mm Amplatzer® Septal-Occluder system guide was introduced via the thoracostomy incision, and placed under simultaneous fiberoptic bronchoscopy visualization, with no complications (Fig. 1A and B).

Fig. 1.
(0.09MB).

Figures A and B show the moment when the system was placed: (A) shows the view through the flexible fiberoptic bronchoscopy of the successful Amplatzer® placement, after deployment. (B) shows the view through the thoracostomy, at the time of release of the Amplatzer® placement system. Figures C and D show the results 3 months after placement: (C) shows the view through the flexible fiberoptic bronchoscopy of the closed fistula in the RUL stump. (D) shows the view through the thoracostomy.

The patient's progress was satisfactory (Fig. 1C and D), and the thoracostomy could be closed after several months.

References
1
M.R. Kramer,N. Peled,D. Shitrit,E. Atar,M. Saute,D. Shlomi
Use of Amplatzer™ device for endobronchial closure of bronchopleural fistulas
Chest, 133 (2008), pp. 1481-1484 http://dx.doi.org/10.1378/chest.07-1961
2
J.A. Fernández-Díaz,C. García-Gallo,J. Goicolea-Ruigómez,A. Varela-de Ugarte
Uso de dispositivo amplatzer® para el cierre de fístulas broncopleurales un procedimiento híbrido mediante broncoscopia y radiología
Rev Esp Cardiol, 64 (2011), pp. 1065-1066 http://dx.doi.org/10.1016/j.recesp.2010.12.006

Please cite this article as: Triviño Ramírez AI, Merino Sánchez M, García Polo C. Manejo de fístula broncopleural mediante colocación del dispositivo Amplatzer®. Arch Bronconeumol. 2017;53:637.

Corresponding author. (Ana Isabel Triviño Ramírez atrivi_17@hotmail.com)
Copyright © 2017. SEPAR
Arch Bronconeumol 2017;53:637 - Vol. 53 Num.11 DOI: 10.1016/j.arbr.2017.09.005