A Novel Approach to Facilitate an Ideal Surgical Correction of Congenital Lobar Emphysema by Using Neonatal Ultrathin Bronchoscopy-Guided Endo-Bronchial Block

Abstract

This is a case report of a child who had acyanotic congenital heart disease -ventricular septal defect (VSD) and a patent ductus arteriosus (PDA) with severe pulmonary arterial hypertension. The child underwent open-heart surgery -VSD closure with PDA ligation -and six months later was re-admitted for congenital lobar emphysema of the right middle lobe. He underwent successful right middle lobectomy of the lung six months after cardiac surgery under a one-lung ventilation technique in which application of fiber-optic bronchoscope made the surgery safer and more suitable.

Congenital lobar emphysema: A diagnostic dilemma with coexistent congenital heart defects

“…Many a time, CLE gets corrected with the relaxation of the vascular compression on the repair of the large left‐to‐right shunt and reduction of pulmonary hypertension 5,9 . Lobectomy can lead to drastic improvement and is well tolerated 10 …”

Congenital Lobar Emphysema Presenting as Respiratory Distress in a Newborn

“…Associated congenital anomalies involving the cardiovascular system (14-20%), followed by the renal, musculoskeletal, and gastrointestinal systems, are well documented. Clinical manifestations of other anomalies can sometimes be so prominent that CLE is easily overlooked [ 2 , 7 ]. Preoperative echocardiography, contrast-enhanced CT scan of the chest, renal function test, and other investigations are recommended to rule out any associated congenital anomalies [ 4 , 6 ].…”

“…Surgical lobectomy is the most widely used treatment option, with excellent results; however, medical management can be considered for asymptomatic or mildly symptomatic patients [ 6 , 7 ]. A few surgeons have also advocated for segmental lung resection rather than lobectomies [ 10 ].…”