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A6318 - Characterizing Bronchoalveolar Lavages and Bronchial Casts in Patients with Congenital Heart Disease and Plastic Bronchitis at Time of Percutaneous Lymphatic Intervention
Author Block: A. Geanacopoulos1, Y. Dori2, M. Itkin3, E. Pinto2, J. Johnstone2, J. Piccione1, S. Goldfarb1; 1Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States, 2Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, United States, 3Division of Interventional Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States.
RATIONALE: Plastic bronchitis (PB) is a rare but possibly life-threatening complication of surgically corrected congenital heart disease (CHD). Lymphatic intervention is a promising new therapy for PB. We characterized bronchoalveolar lavages (BAL) and bronchial casts for patients with surgically corrected CHD and PB at time of lymphatic intervention.
METHODS: We reviewed patients undergoing lymphatic intervention at our institution from March 2014 to May 2017. Patients were included only if they had both surgically corrected CHD and PB, along with a bronchoscopy during hospitalization for lymphatic intervention. We collected BAL cell counts, virology testing, culture growth, and cast morphology. Fontan pressures were obtained from cardiac catheterizations performed within one year prior to or on the day of intervention.
RESULTS: 55 patients met inclusion criteria. 6 patients had 2 lymphatic interventions, and 1 patient had 3, resulting in 63 bronchoscopies. The median age at intervention was 9.4 years (range 2.3-31.2 years), and the median duration of PB, calculated as time from first cast to intervention, was 299 days (range 15 days-8.3 years). The median Fontan pressure was 14.6 mmHg (range 7.0-21.5 mmHg). 90.4% of cases reviewed were associated with cast production within 1 month of lymphatic intervention. Mean BAL counts for lymphocytes, neutrophils, macrophages, and eosinophils were 24.0 (range 0-98), 28.7 (0-95), 40.2 (0-99), and 0.6 (0-10), respectively. Of 42 BALs analyzed for viruses, 16.7% were positive, 4 for rhinovirus, 1 for both parainfluenza 3 and rhinovirus, and 1 each for adenovirus and human metapneumovirus. Of 54 BALs sent for mycobacterial and fungal cultures, 0 grew mycobacteria and 5 (9.3%) grew fungal species, either Candida albicans or Aspergillus fumigatus. Of 56 BALs sent for bacterial culture, 7 (12.5%) were positive, including H. influenzae, M. catarrhalis, S. aureus, and P. aeruginosa. 15 bronchial cast pathology reports were available for review. 13 were inflammatory with eosinophils, neutrophils, and lymphocytes, and 2 were acellular.
CONCLUSION: Our study describes the characteristics of BAL and bronchial casts at time of intervention in patients with CHD and PB and reveals a high percentage of associated infections. The cellular morphology seen in the majority of casts contrasts with the acellular casts of patients with CHD described in the literature. Future investigation of this data will allow for regression analysis of these variables with long-term outcomes to identify predictors of intervention response and inform management.