Treatment Of Pulmonary Sequestration Research Articles

Short- and mid-term outcome of transcatheter embolization of pulmonary sequestration in children: A single-center 22-years experience

A pulmonary sequestration (PS) is a non-functioning bronchopulmonary tissue, not connected to the tracheobronchial tree and receiving arterial supply from the systemic circulation. Recently, transcatheter embolization of the feeding arteries has been reported as an effective and minimally invasive option but large series on outcomes in children are scarce. We aimed to evaluate the efficacy of endovascular embolization of PS and report short- and mid-term outcomes. Single-center retrospective clinical data review of all children referred to Cath lab at M3C-Necker-Enfants–Malades hospital for PS between Jan-1999 and May-2021. Demographic, clinical and procedural data were collected at baseline and at follow-up. Seventy-one patients were included. Median age and weight were 4.9 months (IQR: 2.1–26.6) and 4.2 kg (IQR: 3.9–12.1) respectively. Sixty-one (86%) patients had CHD, of which 47 had scimitar syndrome. Fifty-three (74.7%) patients had transcatheter embolization of PS. At baseline, 36 (68%) patients had PHT. One (1.4%) procedural death was reported. Two (2.8%) patients had PS surgical ligation that was too large for embolization. No patient needed PS surgical resection. Median follow-up was 36.4 months (IQR: 2.1–89.9) without residual shunt. Eight (11.3%) patients died with a median delay of 2.2 (IQR: 1.3–14.4) months after the procedure. Death was related to complex CHD. Thirty-one (86.1%) patients from those who had PHT became (PHT-Free) at last FU. Endovascular treatment of PS in children is safe and effective therapeutic option with very good short- and mid-term results leading to improvement in survival rates and to significant decrease in pulmonary hypertension.

Clinical Outcomes of Transarterial Embolization in the Treatment of Pulmonary Sequestration.

To assess the safety and efficacy of transarterial embolization (TAE) for pulmonary sequestration (PS). A single-center, retrospective study was conducted from March 2013 and December 2020. Patient characteristics, laboratory/imaging, complications, and the TAE procedure were reviewed. We report 11 symptomatic patients with PS successfully treated by TAE. The aberrant supplying arteries were embolized, and there were no immediate complications. One to three days after TAE, patients complained of mild chest pain (n = 4), moderate chest pain (n = 3), and low-grade fever (n = 1). Chest pain symptoms were completely resolved after 2-4days. One patient with PS and bronchiectasis required thoracoscopic resection due to continued symptoms. The remaining 10 patients showed disappearance of chest pain and hemoptysis and decreased lesion size at 2weeks and 3months, with a clinical success rate of 90.9%. TAE may be a feasible alternative treatment for pulmonary sequestration.

Surgical treatment of pulmonary sequestration in adults and children: long-term results.

Few experiences comparing paediatric and adult patients treated for pulmonary sequestration (PS) have been reported. Surgical treatment is considered the best choice, but the time of surgery is still controversial. We present our experience in this setting, comparing characteristics, histological results and outcome of paediatric and adult patients undergoing PS resection. Between 1998 and 2017, a total of 74 patients underwent lobectomy or sublobar resection for PS. Sixty patients were children (group A: ≤16 years old) and 14 were adults (group B: >16 years old). Preoperative diagnosis was radiological. PS was intralobar (42 cases) and extralobar (32 cases). The operation was a muscle-sparing lateral thoracotomy or video-assisted thoracoscopic surgery. Preoperative characteristics, histological results and short-/long-term results of the 2 groups were retrospectively analysed and compared. Thirty-seven percent of the patients in group A presented with respiratory symptoms and 79% in group B (P = 0.44). Most symptomatic patients were treated with a lobectomy. In group A, 2 patients (3%) had a malignant transformation of the lesion. Patients with a prenatal diagnosis treated after the age of 1 year became more symptomatic than those operated on before the age of 1 year (57% vs 23%; P = 0.08). No differences were found in postoperative complications. Long-term stable remission of respiratory symptoms was obtained in 91% of patients in group A and 100% in group B. Adulthood (P = 0.03) and the association with congenital cystic adenomatoid malformation (P = 0.03) were negative prognostic factors for the development of respiratory symptoms. Surgical treatment of PS is safe and feasible. Despite the small number of patients included, study results indicated that an early operation during childhood may prevent the subsequent development of respiratory symptoms. Surgical treatment is also recommended to prevent the rare transformation into malignancy.

PO634 Endovascular Treatment of Pulmonary Sequestration In a South American Pediatric Hospital

PO634 Endovascular Treatment of Pulmonary Sequestration In a South American Pediatric Hospital

Distribution, diagnosis, and treatment of pulmonary sequestration: Report of 208 cases

ObjectiveThis study was performed to explore the clinical features, typing, distribution, and treatment of pulmonary sequestration (PS), with the aim of improving the awareness and treatment of this condition. MethodsClinical data regarding surgical procedures, outcomes, and prognosis of 208 pediatric patients with PS who were treated in our center from January 2005 to October 2017 were retrospectively analyzed. ResultsPS was confirmed by ultrasonography, enhanced computed tomography (CT), and/or magnetic resonance imaging (MRI) before surgery, and the surgeries were smoothly performed in all 208 patients (138 males, 70 females; age, 1 month to 14 years; mean age, 19.70 ± 48.82 months). The operative time ranged from 10 to 230 min (mean, 70 ± 48.75 min), and the intraoperative blood loss volume ranged from 1 to 200 ml (mean, 5 ± 18 ml). PS was located in multiple sites of the thoracic cavity and was also found in some rare locations such as the neck and abdomen. The feeding arteries of the PS mainly arose from the thoracic aorta or abdominal aorta, and a few of them originated from other vessels in the systemic circulation. The venous drainage differed between intralobar and extralobar PS: in patients with intralobar PS, the venous drainage was mainly via the pulmonary veins, especially the lower pulmonary veins; in patients with extralobar PS, the venous drainage was via the azygos vein and hemiazygos vein or reached the right atrium via the vena cava. The infection rate in children with intralobar sequestration was 71.17% (79/111), and that in children with extralobar sequestration was 31.37% (16/51). ConclusionPS has increasingly been detected by prenatal ultrasonography, and enhanced CT and MRI are the main techniques for diagnosing PS. Once confirmed, PS should be surgically resected. We choose an age of 6 to 12 months for surgical resection. Minimally invasive video-assisted thoracic surgery has many advantages in the treatment of PS and can be the treatment of choice for this condition. Type of studyTreatment Study. Level of evidenceLevel III.

Felnőttkori intrapulmonalis sequestratio kezelése videothoracoscopos lobectomiával

Surgical removal is the gold standard method for the treatment of pulmonary sequestration (PS); nowadays, video-assisted thoracoscopic lobectomy (VATS) is more frequently applied in the surgical treatment of malignant pulmonary tumours and appears to be suitable also in case of benign pulmonary diseases. We are the first in Hungary, who report three, radiologically identified intralobar PS treated with VATS. Surgeries were performed in general anaesthesia with double-lumen separated ventilation in lateral decubitus position through two ports (1.5 cm camera port and 5-6 cm axillary working port, protected by a plastic ring). Results and cases: Two of the patients presented with the symptoms of haemoptysis and pneumonia, and the third patient after radiological screening (one 37 years old woman and 2 men, 39 and 46 years old). The nutritive artery was identified on the CT scans in all cases. We removed the right lower lobe in two cases and the left lower lobe in one case without major complications. We recommend the video-thoracoscopic lobectomy for the treatment of PS as a suitable treatment option.

Hybrid surgery in treatment of pulmonary sequestration with abdominal aorta feeding vessel: a case report

BackgroundPulmonary sequestration is a rare congenital pulmonary dysplasia, which requires surgical resection (either via open thoracotomy or video-assisted thoracoscopic surgery [VATS] or via endoluminal occlusion of the abnormal feeding vessel).Case presentationWe described a 51-year-old female patient with a history of recurrent cough and repeated pneumonia. She was referred to our hospital for further work-up of pulmonary sequestration. We performed a hybrid surgery (i.e., embolization of the aberrant feeding vessel of the sequestration combined with wedge resection of the left lower lobe lesion through VATS). The patient was discharged on the sixth postoperative day in good condition and without complications.ConclusionsWe believe that a hybrid operation is safer, more feasible, and more comprehensive than other treatments.

Pulmonary sequestration in children. postnatal course, diagnosis and surgical treatment

The aim — to optimize the diagnostic and treatment of pulmonary sequestration in children on the basis of clinical and diagnostic data and treatment results study.Materials and methods. The study included 14 patients aged 8 days to 17 years, 3 of which were newborns, 4 — from 1 to 12 months, 3 — from 1 to 3 years, 2 — 7­8 years, and 2 — 15 — 17 years old. There were 8 (57.1 %) boys and 6 (42.9 %) girls. Postnatal diagnosis was based on contrast computed tomography or angiography. In all cases the surgical treatment was performed. In 5 cases, the diagnosis of pulmonary sequestration was established intraoperatively during the surgery for mediastinal tumor, congenital diaphragmatic hernia or polycystic lung.Results and discussion. Ten (71.4 %) patients had intralobar sequestration and another 4 (28.6 %), extralobar one (p = 0.099), left­side localization was in 9 (64.3 %) cases, right­side in 5 (35.7 %). Associated malformations were found in 7 (50.0 %) patients and included polycystic lung (n = 3), lung hypoplasia (n = 2), diaphragmatic hernia (n = 2), pericardial defect (n = 1), thoracic dystopia of kidney (n = 1), Waardenburg syndrome (n = 1). Twelve (85.7 %) patients had a symptomatic disease presented with respiratory or hemodynamic disorders, signs of inflammation and hemophtysis. Lobectomy (n = 4), segmental lung resection (n = 4) or division of aberrant vessels (n = 2) were used in cases of intralobar disease depending on the extent of lesion while sequesterectomy (n = 4) was performed in extralobar sequestration. Simultaneous diaphragmoplasty, including that with use of bounded autopericardial flap (n = 1) was performed in 2 cases of associated diaphragmatic hernia. There were no postoperative complications and mortality. Late follow­up examination within the period from 4 to 22 years after the operation showed positive results in all 100 % of cases.Conclusions. Pulmonary sequestration, since the diagnosis is established, is subject to compulsory surgical correction, the effectiveness of which reaches 100 %. Correction of intralobar sequestration consists of lobectomy or segmental resection of the lungs, in the case of extralobar disease sequesterectomy is indicated. Associated congenital diaphragmatic hernia can be effectively corrected by diaphragmoplasty, including that with use of autopericardium.

Retrospective review of the diagnosis and treatment of pulmonary sequestration in 28 patients: surgery or endovascular techniques?

Pulmonary sequestration (PS) is a rare congenital pulmonary malformation. In this study, we aimed to retrospect and evaluate the diagnosis, treatment, and outcomes of PS in 28 patients at our institute. The files of 28 patients with PS who were treated with surgery (21 cases) or endovascular intervention (7 cases) between May 2005 and June 2016 from a single institute were retrospectively reviewed. The following data of all patients were analyzed: age, sex, clinical symptoms, diagnostic methods, operative techniques, and treatment outcomes. Twenty-eight patients, 15 male and 13 female, with a median age of 42.5 underwent operative intervention for PS. Twenty-one patients showed preoperative symptoms including cough, expectoration, hemoptysis, chest and/or back pain, and fever. General chest computed tomography (CT) scanning; percutaneous needle biopsy, bronchoscopy, enhanced CT scanning, and CT angiography (CTA) were used as diagnostic methods. Twenty-one patients were diagnosed preoperatively by enhanced CT scanning and CTA; seven patients were confirmed by surgery. Twenty-one patients underwent surgery (15 cases via thoracotomy and 6 cases via video-assisted thoracic surgery), seven patients underwent interventional therapy (three cases via endovascular embolization and four cases via thoracic aortic endovascular stent-graft exclusion). Three patients had a complication in surgery group (intraoperative hemorrhage in two patients and postoperative hydropneumothorax in one patient) and two patients had post-embolization syndrome in interventional group (fever and pain at embolism site). During the follow-up period ranging from 6 to 84 months, no recurrences or further complications were observed in two groups. Enhanced CT or CTA may be a potential approach for the diagnosis of PS. Surgical resection for PS is the major treatment approach. Endovascular embolization of PS could be considered when pulmonary lesion is small-sized. Endovascular exclusion could be used to treat combined arterial aneurysm and dissection of PS.

Video-assisted thoracic surgery for pulmonary sequestration: a safe alternative procedure.

Pulmonary sequestration (PS), a rare congenital anatomic anomaly of the lung, is usually treated through resection by a conventional thoracotomy procedure. The efficacy and safety of video-assisted thoracic surgery (VATS) in PS treatment has seldom been evaluated. To address this research gap, we assessed the efficacy and safety of VATS in the treatment of PS in a large Chinese cohort. We retrospectively reviewed 58 patients with PS who had undergone surgical resection in our department between January 2003 and April 2014. Of these patients, 42 (72.4%) underwent thoracotomy, and 16 (27.6%) underwent attempted VATS resection. Clinical and demographic data, including patients' age, sex, complaints, sequestration characteristics, approach and procedures, operative time, resection range, blood loss, drainage volume, chest tube duration, hospital stay, and complications were collected, in addition to short-term follow-up data. Of the 58 participating patients, 55 accepted anatomic lobectomy, 2 accepted wedge resection, and 1 accepted left lower lobectomy combined with lingular segmentectomy. All lesions were located in the lower lobe, with 1-4 aberrant arteries, except one right upper lobe sequestration. Three cases (18.8%) in the VATS group were converted to thoracotomy because of dense adhesion (n=1), hilar fusion (n=1), or bleeding (n=1). No significant differences in operative time, postoperative hospital stay, or perioperative complications were observed between the VATS and thoracotomy groups, although the VATS patients had less blood loss (P=0.032), a greater drainage volume (P=0.001), and a longer chest tube duration (P=0.001) than their thoracotomy counterparts. VATS is a viable alternative procedure for PS in some patients. Simple sequestration without a thoracic cavity or hilum adhesion is a good indication for VATS resection, particularly for VATS anatomic lobectomy. Thoracic cavity and hilum adhesion remain a challenge for VATS.

Pulmonary Sequestration: A 29 Patient Case Series and Review.

Pulmonary sequestration also known as bronchopulmonary sequestration is a rare disease, with very few case series reviewed in literature. In this study, we review the demographics, presentation, imaging and treatment of pulmonary sequestration in 29 patients from our institution, and provide comparison data from previously published series with an overview of the disease history. Records reviewed for all patients evaluated and treated in our institution with a pathological proven diagnosis of pulmonary sequestration from January 2004 through December 2013. Collected data included demographics, clinical presentation, diagnostic imaging, location of the lesion, type of sequestration, and subsequent treatment. Of the 29 patients reviewed 8 (28%) were children 0-2 years, 1 adolescent age 17, and 20 (69%) adults 21-70 years with a mean age of 42 among adults. Systemic arterial supply to the sequestered segment was demonstrated with computed tomographic angiography (CTA) in 25 patients (86%). In 19 patients (66%), the sequestered segment was located in the left lower lobe, and 16 (55%) were intralobar. Diagnostic delays of pulmonary sequestration were common among the adult population as the presenting symptoms often mimicked other common pulmonary diseases, such as pneumonia and asthma. These findings were consistent among previously published series. CTA was the preferred imaging modality for preoperative planning with high sensitivity and specificity in identifying the lesion.

Secuestro pulmonar: Serie clínica de 16 pacientes

Objective: To describe our experience with sixteen children treated for pulmonary sequestration at the Children 's Hospital Roberto del Rio, between 2000 and 2012. Method: We reviewed retrospectively the clinical charts of all those patients up to 15 years old, who were treated for pathologically proven pulmonary sequestration in our hospital, between 2000 and 2012. Results: Sixteen patients were recorded, 8 boys and 8 girls that were diagnosed and/or treated between the newborn period and 14 years old. Nine of them had extralobar sequestration and 7 intralobar. The diagnosis was suspected for persisting pneumonia in 44%, neonatal respiratory distress in 25%, prenatal ultrasound in 19%, and recurrent pneumonia in 12%. Seventy-five percent of sequestrations were located in the left lower lobe, 19% in the right lower lobe and 6% in the right upper lobe and all of them were operated via thoracotomy. Fifty-six percent underwent surgery before one year of age (31.5% before 2 weeks of life) and 69% of patients did well postoperatively. Postoperative atelectasis were detected in 12.5%, bronchopleural fistula in 12.5% and residual pneumothorax in 6%. The average hospital stay was 9 days and no mortality was registered. Conclusions: Our experience is similar to the previously reported series and emphasizes the importance of early diagnosis in the treatment of pulmonary sequestration in children.

Treatment of Pulmonary Sequestration with Thoracoscopic Approach

Pulmonary sequestration (PS) is a rare congenital malformation of the lower respiratory tract. The anomaly is characterized by absence of communication with the tracheobronchial tree and isolated blood supply from an anomalous systemic vessels. With the utilization of antenatal ultrasound, the diagn...

Diagnosis and treatment of pulmonary sequestration

To explore the clinical manifestations and treatment of pulmonary sequestration. Thirty-five patients with pulmonary sequestration confirmed by pathological studies were analyzed. Among these patients, 29 were of intralobar type and 6 of extralobar type. All patients of intralobar type had symptoms of cough, expectoration, fever and hemoptysis while 6 cases of extralobar type were asymptomatic. Twenty-three cases were diagnosed preoperatively by enhanced CT scan, CT angiography or selective arteriography. Success of operation had been achieved in all cases. The clinical manifestations of pulmonary sequestration are non-specific. Though invasive, selective arteriography plays a decisive role in the diagnosis. Such non-invasive angiographies as enhanced CT scan and CT angiography have become important supplements to it. Once the diagnosis is confirmed, operation should be performed.

Fetal thoracoamniotic shunting as the only treatment for pulmonary sequestration with hydrops: favorable long‐term outcome without postnatal surgery

Although it is established that bronchopulmonary sequestration complicated by fetal hydrops carries a high risk of perinatal mortality, prenatal management remains controversial. Therapeutic options include immediate delivery, medical therapy based on an inotropic regimen, alcohol ablation of the vascular pedicle, open fetal surgery, or thoracoamniotic shunting of fetal pleural effusions. We report a case of pulmonary sequestration with hydrothorax and fetal hydrops which was successfully treated by a single fetal thoracoamniotic catheter drainage. Following emergency catheter placement, hydrothorax and hydrops decreased dramatically. The sequestration gradually disappeared postnatally, and long-term outcome remained normal without any postnatal therapy. Based on this observation, the natural history of pulmonary sequestration and prenatal management options are reviewed.

Antenatal diagnosis and treatment of fetal hydrops secondary to pulmonary extralobar sequestration.

Bronchopulmonary sequestration with associated non-immune hydrops has been previously reported with generally poor prognosis for the neonate. The vast majority of sequestrations are discovered postnatally, and less than half are correctly identified as sequestration before birth.Until recently, treatment for pulmonary sequestration was limited to postnatal respiratory support and resection of the sequestered lung. But aggressive respiratory support does not succeed in salvaging infants with underlying pulmonary hypoplasia. In our report, we describe the antenatal treatment of pleural effusions complicated by hydrops fetalis secondary to a bronchopulmonary sequestration, successfully managed with a transthoracic catheter placement. This therapy resulted in the resolution of pleural effusion, polyhydramnios and hydrops, with a good fetal outcome.

Congenital Cystic Disease of the Tracheobronchial Tree in Infants and Children

Cystic anomalies of the tracheobronchial tree in infants and children are usually of congenital origin and consist of pulmonary sequestration (PS), cystic adenomatoid malformation (CAM), congenital lobar overinflation (CLO), and bronchogenic cyst (BC). These four anomalies present a different clinical picture, are often difficult to diagnose, and require surgical management. From December 1974 to April 1993, 44 patients were operated on for congenital cystic disease of the tracheobronchial tree. There were 25 male patients (57%) and 19 female patients (43%), ranging in age from 1 day to 18 years. Thirty-three children (75%) were younger than 1 year and 31 (70%) were younger than 6 months at the time of surgery. There were 17 CAMs (38%), nine intralobar (20%) and six extralobar (13%) PSs, seven CLOs (16%), and six BCs (13%). All patients with CAM, CLO, and intralobar PS were symptomatic and presented with either progressive respiratory distress or recurrent pulmonary infections with cystic changes noted on chest roentgenograms. Computed tomography was the most definitive diagnostic study performed, aided by selective use of ultrasonography and arteriography. All patients with CAM, CLO, and intralobar PS were treated with lobectomy; no segmentectomies were performed. Extralobar PSs and BCs were managed with resection of the cyst alone. There was one death (2%) in this series in a 1-day-old infant with a CAM who died of bilateral pulmonary hypoplasia. The remaining 43 patients (98%) are alive and well to date, with follow-up ranging from 2 months to 19 years. None of the patients who underwent a lobectomy have suffered any physical limitations during subsequent growth and development. Congenital cystic disease of the tracheobronchial tree can be diagnosed with computed tomography and selective use of ultrasonography and arteriography. Lobectomy is the appropriate treatment for CAM, CLO, and intralobar PS and is well tolerated without any subsequent long-term limitation in physical activity.