Cardiology MCQ: Plastic bronchitis
Plastic bronchitis is seen after:
a) ASD repair
b) Arterial switch
c) Fontan repair
d) VSD closure
Correct answer: c) Fontan repair
Plastic bronchitis is characterised by marked obstruction of the large airways due to the formation of bronchial casts with rubber like consistency. Elevated central venous pressure leading to endobronchial lymph leakage is thought to be the mechanism of plastic bronchitis in post Fontan state. Plastic bronchitis can occur in those without heart disease as well. In those due to inflammatory lung disease, the casts are cellular (type I casts) while in those with underlying heart disease, the casts are acellular (type II casts). Plastic bronchitis has been described after other cardiac surgeries as well [Brogan TV et al. Plastic bronchitis in children: a case series and review of the medical literature. Pediatr Pulmonol. 2002;34:482-7].
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ASD (atrial septal defect) repair, VSD (ventricular septal defect) closure and arterial switch operations are usually considered as ‘curative’ operations without much residual defects. But Fontan repair is at best a palliative procedure as the hemodynamics does not even resemble a normal state after repair. It is a univentricular type of repair in which the dominant ventricular chamber works as the systemic pump while the pulmonary flow is maintained by passive flow from the systemic venous drainage. In order to overcome the pulmonary vascular resistance, though much smaller than systemic vascular resi...
Source: Cardiophile MD - Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiac Surgery Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
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