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Correspondence |

Minimally Invasive Closure of Bronchopleural FistulasClosure of Bronchopleura FREE TO VIEW

Miguel L. Tedde, MD, PhD; Paulo R. Scordamaglio, MD; Ascedio Rodrigues, MD; Helio Minamoto, MD, PhD; Fernanda S. Alfinito, MD
Author and Funding Information

From the Thoracic Surgery Department (Drs Tedde, Minamoto, and Alfinito) and Respiratory Endoscopy (Drs Scordamaglio and Rodrigues), Heart Institute (InCor) do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo.

Correspondence to: Miguel L. Tedde, MD, PhD, R. Itambé, 367 ap 151 A, 01239-001 Higienópolis, São Paulo, Brazil; e-mail: tedde@usp.br


Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Drs Tedde, Scordamaglio, Rodrigues, Minamoto, and Alfinito are conducting a study (clinicaltrials.gov; Identifier: NCT01153074) for which Occlutech International AB has donated 15 Occlutech Figulla ASD Occluder N devices for a clinical protocol.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(3):826. doi:10.1378/chest.11-0719
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We would like to congratulate Fruchter et al1 for their ingenious, effective, and minimally invasive way of treating the very challenging condition of bronchopleural fistulas as reported in a recent issue of CHEST (March 2011). However, because we were cited in their work, we must make a correction. The misunderstanding is that our first publication was a case report of our first patient (53-year-old man with a right upper lobectomy) using this method.2 Later, Scordamaglio et al3 published a review of our experience endoscopically treating airway fistulas (two bronchopleural and one tracheoesophageal), which included this same patient. Since then, five more fistulas in four other patients have been treated, making a total of seven fistulas treated in six patients (one patient with two fistulas), with five of them already closed. Although the technique used is similar to that in Fruchter et al,1 there are small differences we believe are worth noting.

Unlike Fruchter et al,1 we used the Occlutech Figulla ASD Occluder N (Occlutech International AB; Helsingborg, Sweden) because this device has a design that makes it more malleable. Fruchter et al1 stated that “bronchography was performed to outline the anatomy of the fistula, in particular its length.” Because we treated only total fistulas, the “fistula length” was not a concern in our cases because we could see the end of the stump with the bronchoscope. In our cases, the diameter of the fistula was the most relevant measure for choosing occluder size. We estimated diameter by insufflating a ballooned catheter or an endobronchial blocker inside the fistula. Consequently, we have not used fluoroscopy or bronchography.

Finally, we agree with the authors’ statement that the procedure can be carried out in a bronchoscopy suite in patients under conscious sedation, which is the most remarkable distinction between the classic surgical procedure of treating this condition and this new minimally invasive method. Once again, we congratulate the authors for their valuable contribution.

Other contributions: This work was performed at the Thoracic Surgery Department, Heart Institute (InCor) do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo.

Fruchter O, Kramer MR, Dagan T, et al. Endobronchial closure of bronchopleural fistulae using amplatzer devices: our experience and literature review. Chest. 2011;1393:682-687 [CrossRef] [PubMed]
 
Tedde ML, Scordamaglio PR, Minamoto H, Figueiredo VR, Pedra CC, Jatene FB. Endobronchial closure of total bronchopleural fistula with Occlutech Figulla ASD N device. Ann Thorac Surg. 2009;883:e25-e26 [CrossRef] [PubMed]
 
Scordamaglio PR, Tedde ML, Minamoto H, Pedra CA, Jatene FB. Endoscopic treatment of tracheobronchial tree fistulas using atrial septal defect occluders: preliminary results. J Bras Pneumol. 2009;3511:1156-1160 [CrossRef] [PubMed]
 

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References

Fruchter O, Kramer MR, Dagan T, et al. Endobronchial closure of bronchopleural fistulae using amplatzer devices: our experience and literature review. Chest. 2011;1393:682-687 [CrossRef] [PubMed]
 
Tedde ML, Scordamaglio PR, Minamoto H, Figueiredo VR, Pedra CC, Jatene FB. Endobronchial closure of total bronchopleural fistula with Occlutech Figulla ASD N device. Ann Thorac Surg. 2009;883:e25-e26 [CrossRef] [PubMed]
 
Scordamaglio PR, Tedde ML, Minamoto H, Pedra CA, Jatene FB. Endoscopic treatment of tracheobronchial tree fistulas using atrial septal defect occluders: preliminary results. J Bras Pneumol. 2009;3511:1156-1160 [CrossRef] [PubMed]
 
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