Expiratory Dynamic Collapse of Trachea (DCT) was recently recognized as a possible mechanism for congestive heart failure (CHF). We studied the short and long term hemodynamic impact of tracheal stenting on DCT-CHF.
A 68 year-old male was evaluated for repeated episodes of CHF after prolonged coughing spells in spite of different treatments. Extensive cardiac and pulmonary diagnostic evaluation for CHF was unrevealing. At bronchoscopy, there was >90% expiratory collapse of the lower 6 cm of the posterior tracheal wall, without cartilaginous involvement. The hemodynamic impact of DTC was assisted by impedance cardiography with stroke volume index (SVI) measured at rest, during coughing, then two and four minutes after cessation of cough (Figure 1). Similar hemodynamic measurements (HM) were obtained six and twelve months after placement of an uncovered ultraflex tracheal stent (Microvasive, Natick, MA) to support the collapsible portion of the trachea.
At six and twelve months post-stenting the patient had no recurrence of CHF with HM demonstrated a statistically significant stabilization of the SVI (p<0.01) (Figure 1).
This was the first documented report of DCT-CHF with cough induced intrinsic-positive end expiratory pressure leading to decrease in SVI. The later was reversed by tracheal stenting with the benefits persisted at six and twelve months follow up. A prospective study is currently under way for further evaluation of that process.
Expiratory Dynamic Collapse of Trachea should be considered in the work up of congestive heart failure.
Faisal Khan, None.