J.T. Janson

CMV pneumonia in HIV-infected ventilated infants

The contributing role of cytomegalovirus (CMV) in infants treated for Pneumocystis jiroveci pneumonia (PJP) is unknown. High dose steroids used in the treatment of PJP may further immunocompromise these infants contributing to the development of CMV pneumonia.

Transjugular Tricuspid Valve-in-Valve Replacement

The patient is a 38-year-old woman with rheumatic heart disease requiring surgery 21 years ago. She received a St. Jude mechanical prosthesis in the mitral position and a Carpentier-Edwards Perimount bioprosthesis (size 31) in the tricuspid position. Over the past 2 years, she has become progressively more short of breath with regular admissions for congestive heart failure despite medical treatment. Transthoracic echocardiography showed a severely dilated right atrium and a calcified tricuspid prosthesis with a mean gradient across the valve varying between 9 and 12 mm Hg (Figures 1 and 2). The mitral valve prosthesis functioned well. Figure 1. The continuous wave spectral Doppler of the degenerate tricuspid prosthesis before the procedure showing a profile of severe tricuspid stenosis with averaged (because of atrial fibrillation) peak and mean gradients of 12 and 9, respectively. Vmax indicates maximum flow velocity; Vmean, mean flow velocity; Pmax, maximal pressure gradient: Pmean, mean pressure gradient; Env Ti, duration of measured envelope; VTI, velocity time integral; HR, heart rate. Figure 2. Pressure half-time (PHT) measured over the tricuspid valve confirms severe tricuspid stenosis with a value of 461 ms. A decision was made to replace the tricuspid valve, but in consultation with the heart team, it was agreed that, given that the mitral valve prosthesis was functioning well, the risk of a second sternotomy to replace only the tricuspid valve was difficult to justify if an alternative option was available. Given the limited lifespan of a bioprosthesis in a young person, she would then require her third (and likely final) sternotomy at a young age. A joint decision was therefore made to offer the patient a minimally invasive tricuspid valve replacement by a transcatheter procedure. The risks of a transcatheter procedure were discussed with her, and she provided written informed consent. The option of a …

Fibrin glue closure of persistent bronchopleural fistula following pneumonectomy for post-tuberculosis bronchiectasis

We report a case of a persistent bronchopleural fistula following a pneumonectomy for post‐tuberculosis bronchiectasis. The patient had two unsuccessful surgical attempts at closing of the fistula. Further surgical attempts were technically were not possible. Bronchoscopic closure was achieved by injecting human fibrin glue into the fistula via a catheter. Closure of the broncho‐pleural fistula was confirmed by repeated ventilation scan over a period of 2 months. Endoscopic closure of small bronchopleural fistulae is an attractive option in children with significant underlying lung disease. Pediatr Pulmonol. 2008; 43:721–725.

Empyema necessitans in a six-month-old girl

Abstract Empyema necessitans is a rare complication of acute bacterial pneumonia, especially in children. It is a complication of empyema characterised by the extension of pus from the pleural cavity into the thoracic wall to form a mass of purulent fluid in the adjacent soft tissue. An inflammatory chest wall mass following pneumonia caused by Streptococcus pneumonia in a six-month-old infant is reported. The case emphasises that children presenting with persistent fever and a painful chest wall mass following pneumonia should be investigated immediately as there might be an urgent need for surgery.

The indications and role of paediatric bronchoscopy in a developing country, with high prevalence of pulmonary tuberculosis and HIV

ABSTRACT Background: Bronchoscopy, an important investigation for the diagnosis and management of respiratory diseases, is widely used in high income countries. There is limited information on value of paediatric bronchoscopy in low and middle income countries (LMIC). Aims and Objectives: Aim was to describe the indications, findings and complications of bronchoscopy in a middle income country with a high prevalence of tuberculosis and HIV. Methodology: A retrospective analysis of a database over a 3.5 year period. Results: A total of 509 bronchoscopies were performed on neonates (2.3%) and children (median age = 18 months) of which 5.1% were HIV-infected. The main indications were: possible large airway compression 40%, complicated pneumonia (25%) and persistent stridor (15%). Pathology was observed in 64% of bronchoscopies. The most findings were lymph node compression of the airways (21%), and upper airway pathology (12%). Interventional procedures were performed in 112 cases (22%), the commonest being foreign bodies removal (30%), endobronchial lymph node enucleation (30%) and transbronchial needle aspiration (20%). No major complications. Conclusion: The diagnostic yield of paediatric bronchoscopy did not differ from high income countries emphasising the importance of paediatric bronchoscopy in the management of childhood lung disease in LMICs.

The role of lung surgery in a low income country: The indications, surgical course, complications and short-term outcome and also comparing HIV-infected to HIV-uninfected

P100N The role of lung surgery in a low income country: The indications, surgical course, complications and short-term outcome and also comparing HIV-infected to HIV-uninfected D. Rhode, P. Goussard, S. Kling, A. Vanker, J.T. Janson, B. Barnard, G.J. Rossouw, R.P. Gie. Division of Paediatric pulmonology, Department of Paediatrics and Child health, Tygerberg Children’s Hospital – Tygerberg, South Africa; Cardiothoracic surgery department, Tygerberg Academic Hospital, Stellenbosch University – Tygerberg, South Africa