Whole Lung Lavage of Nine Children with Pulmonary Alveolar Proteinosis: Experience in a Tertiary Lung Center
A 4 year-old boy in whom an already unsuccessful bronchoalveolar lavage by fiberoptic bronchoscopy was complicated by cardiac arrest in another hospital, was admitted to our center. In the operating room, simultaneous lavaging of both lungs was performed after initiation of CPB via right femoral artery (RFA) and vein (RFV) cannulation. Due to repeated dangerous hypoxemia and insufficient venous return, the lavage was discontinued and mechanical ventilation of the lungs reestablished and oxygenation was restored. With advancement of the vascular cannulas to the right atrium and aortic arch for optimal drainage, 10 cycles of lavage of the both lungs were performed within 4 hours. His oxygenation improved and he discharged from the hospital 9 days after procedure. 6 months later, a similar 7 hours procedure was done. After 6 months, the patient was readmitted 2 times for pneumonia and medically treated. In the following 1.5 years the patient has maintained a satisfactory respiratory status.