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(Chest. 2006;130:906-909.)
© 2006 American College of Chest Physicians

First Use of Ventricular Septal Defect Occlusion Device for Endoscopic Closure of an Esophagorespiratory Fistula Using Bronchoscopy and Esophagoscopy*

Thomas Rabenstein, MD, PhD; Christoph Boosfeld, PhD; Rolf Henrich, MD and Christian Ell, MD, PhD

* From the Department of Medicine II (Drs. Rabenstein, Henrich, and Ell), Dr. Horst-Schmidt Klinik Wiesbaden, Wiesbaden; and DRABO Medizintechnik–Amplatzer Support Europe (Dr. Boosfeld), Cologne, Germany.

Correspondence to: Thomas Rabenstein, MD, PhD, Klinik Innere Medizin II, Dr.-Horst-Schmidt-Klinik Wiesbaden, Akademisches Lehrkrankenhaus der Johannes-Gutenberg-Universität Mainz, Ludwig-Erhard-Str 100, 65199 Wiesbaden, Germany; e-mail: thomas.rabenstein{at}hsk-wiesbaden.de

A 70-year-old woman presented with a persistent, nonmalignant esophagorespiratory fistula. Since other treatment options failed or were denied, an experimental nonsurgical therapy was performed. A self-expanding ventricular septal defect (VSD) occlusion device (Amplatzer; AGA Medical Corporation; Golden Valley, MN) was bronchoscopically introduced to close the fistula. The double umbrella-like occlusion device is made from nitinol mesh and closes luminal contact between the esophageal and bronchial walls, with its waist filling out the fistula itself. The geometry of the occluder system can in theory be designed according to individual purposes and needs. The performed treatment was safe and successful, and the patient remained asymptomatic for 1 year after the first presentation. The treatment of chronic nonmalignant esophagorespiratory fistulas can be difficult. The self-expanding VSD occluder system described in this case might be useful in patients who are not surgical candidates.

Key Words: Amplatzer • esophagorespiratory fistula • experimental treatment • interventional endoscopy • nonmalignant • nonsurgical treatment • therapeutic endoscopy • ventricular septal defect occluder






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