A Multifaceted Approach to the Management of Plastic Bronchitis After Cavopulmonary Palliation

The formation of endotracheal casts comprised of inflammatory debris (plastic bronchitis) is a rare but life-threatening complication of the Fontan procedure.  This summary of 14 pts so affected demonstrated a mean interval to development of plastic bronchitis of 1.5 years.  Casts were treated with outpt t-PA (13 pts) and pulmonary vasodilators.  Lesions of the Fontan pathway were hemodynamically significant in 12 pts, and 3 pts required heart transplantation.  2 transplant pts and 6 t-PA pts were asymptomatic at last follow-up.