One-lung ventilation using a Fogarty catheter in an infant with group III congenital bronchopulmonary foregut malformation: A case report

Congenital bronchopulmonary foregut malformation (CBPFM) is a rare congenital anomaly in which portions of the respiratory tract communicate with the upper gastrointestinal system. Surgical resection of the affected pulmonary tissue is often indicated. One-lung ventilation (OLV) can facilitate surgical exposure in such procedures, but its application in small children is technically challenging due to anatomical and equipment limitations. We report a pediatric case of CBPFM successfully managed with OLV using a Fogarty catheter during right upper lobectomy. An 18-month-old female infant with a congenital ventricular septal defect and anorectal malformation was found on preoperative computed tomography to have her right upper bronchus originating from the esophagus, consistent with Group III CBPFM. She experienced intermittent coughing during feeding, but no history of pneumonia. Further evaluation with bronchoscopy and esophagogastroduodenoscopy confirmed a blind-ended right upper lobe bronchus and a fistula in the mid-esophagus with purulent discharge. For surgical resection, general anesthesia was induced, and OLV was established using a 3-Fr Fogarty catheter placed extraluminally into the right main bronchus under bronchoscopic guidance. Stable OLV was maintained throughout the procedure. The anomalous bronchus was successfully resected, and the patient had an uneventful postoperative course apart from a transient pneumothorax managed conservatively. This case demonstrates that stable and effective OLV can be achieved using a Fogarty catheter in infants with Group III CBPFM. Importantly, careful preoperative evaluation of the patient's individual anatomy using CT imaging enabled appropriate selection of both device type and size, as well as planning of the anesthetic approach. Anesthesiologists managing rare congenital airway anomalies must tailor their strategies to each patient's specific anatomy.