UCL Discovery
UCL home » Library Services » Electronic resources » UCL Discovery

Intrathoracic prosthesis in children in preventing post-pneumonectomy syndrome: Its role in congenital single lung and post-pneumonectomy situations

Elliott, M; Quong, WL; Bulstrode, N; Beeman, A; Ramaswamy, M; Sivakumar, B; Wallis, C; (2022) Intrathoracic prosthesis in children in preventing post-pneumonectomy syndrome: Its role in congenital single lung and post-pneumonectomy situations. Journal of Pediatric Surgery 10.1016/j.jpedsurg.2021.10.010. (In press).

[thumbnail of Elliott_1-s2.0-S0022346821007193-main.pdf] Text
Elliott_1-s2.0-S0022346821007193-main.pdf - Accepted Version
Access restricted to UCL open access staff until 23 October 2022.

Download (982kB)

Abstract

Background: Postpneumopnectomy syndrome (PPS) is an extreme rotation and malposition of mediastinum causing dynamic and symptomatic central airway compression, arising after pneumonectomy or more uncommonly, in congenital single-lung physiology. Affected patients present with severe respiratory compromise. Intrathoracic prosthesis placement is an evolving technique in children that mitigate the effects of thoracic dead space. Research Question: Assessment of clinical recovery and functional benefit in children undergoing placement of intrathoracic prosthesis following pneumonectomy or in congenital single lung situations. Study Design and Methods: Retrospective chart review of patients at Great Ormond Street Hospital from 2010 and 2020 was performed of all patients who underwent intrathoracic tissue expander placement. We summarize the outcomes of twenty-four children, including those with both congenital and postpneumonectomy PPS etiology. Results: 24 children who underwent placement of intrathoracic prosthesis for PPS in the study period with median age of 3.5 months and weight of 5 kg. Single lung etiology was congenital in 15 children (6 agenesis, 9 hypoplasia), and postpneumonectomy in 9 children. In seven patients, there was associated long segment tracheal stenosis. Pre-operative ECMO was required in 2 patients, and pre-operative ventilation was required in 12 patients – all of whom had congenital single lung. Intrathoracic prosthesis placement was concurrent with intracardiac repair in 5 patients. There were no operative deaths, but one early postoperative death related to septicaemia. Median follow up was 75 months with 10 patients on continued respiratory support and 3 on nocturnal support with good quality of life. Two children needed reoperations for replacement of prosthesis. Conclusion: The use of tissue expanders is within the armamentarium of most plastic surgeons’ practice. We also therefore advocate for a collaborative team approach involving Plastic and Cardiothoracic Surgery for surgical treatment of these patients. This multidisciplinary strategy has improved management of this rare and debilitating condition of PPS, thereby offering significant improvements in general progress of these sick children having single lung physiology. Evidence is still lacking on functional outcomes in these children and further work is necessary to prove that this is indeed achievable.

Type: Article
Title: Intrathoracic prosthesis in children in preventing post-pneumonectomy syndrome: Its role in congenital single lung and post-pneumonectomy situations
DOI: 10.1016/j.jpedsurg.2021.10.010
Publisher version: https://doi.org/10.1016/j.jpedsurg.2021.10.010
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Post-pneumonectomy syndrome, Intrathoracic prosthesis, Mediastinum
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health
URI: https://discovery.ucl.ac.uk/id/eprint/10137129
Downloads since deposit
1Download
Download activity - last month
Download activity - last 12 months
Downloads by country - last 12 months

Archive Staff Only

View Item View Item