Plastic bronchitis occurring late after the Fontan procedure: treatment with aerosolized urokinase.

OBJECTIVE

To describe the use of aerosolized urokinase in a patient with plastic bronchitis after a Fontan procedure.

DESIGN

Case report.

SETTING

Pediatric intensive care unit in a university-affiliated children's hospital.

PATIENTS: Report of one patient with acute respiratory failure secondary to plastic bronchitis.

INTERVENTIONS: Aerosolized urokinase, multiple bronchoscopies, corticosteroids, mucolytics, bronchodilators, and atrial pacing.

MEASUREMENTS AND MAIN

RESULTS

Airway obstruction secondary to recurring casts improved with the treatments. Histologic analysis of the casts demonstrated less fibrin after treatments with aerosolized urokinase. No adverse events were noted.

CONCLUSIONS

The addition of aerosolized urokinase to this patient's treatment regimen helped to resolve life-threatening airway obstruction secondary to fibrin casts.