Right pneumonectomy syndrome in infancy treated with an expandable prosthesis

Rasch, Deborah K.; Grover, Frederick L.; Schnapf, Bruce M.; Clarke, Ewell A; Pollard, Trevor G.

doi:10.1016/0003-4975(90)90104-e

Cited by 37 publications

(19 citation statements)

References 6 publications

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“…PPS is more common in children than in adults and it is hypothesized that this is because of the increased elasticity and compliance of the remaining lung and mediastinal tissue. This results in a narrowing and twisting of the main bronchus . Furthermore, several studies have reported that this syndrome is more frequent in women than in men.…”

Section: Discussionmentioning

confidence: 99%

Management of post‐pneumonectomy syndrome using tissue expanders

et al. 2015

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BackgroundPost‐pneumonectomy syndrome (PPS) is a rare syndrome characterized by trachea‐bronchial stenosis and severe dyspnea. In this study, we retrospectively evaluated the clinical outcomes in patients who underwent placement of tissue expanders for PPS.MethodsData from patients who underwent placement of tissue expanders for PPS were analyzed for preoperative characteristics, surgical techniques, and postoperative outcomes. Between 1997 and 2014, a total of 10 patients were treated for PPS by tissue expanders.ResultsThe median age of the 10 patients was 45 years (range, 16–70). Four patients had undergone right pneumonectomy, three patients had undergone left pneumonectomy, and three patients had post‐pneumonectomy‐like syndrome. Preoperatively, seven patients initially received high oxygen therapy for hypoxemia but progressed to respiratory failure, and three patients required mechanical ventilator support. Among these three patients, one required intraoperative extracorporeal membrane oxygenation support because of sudden cardiac arrest during preparation for surgery. The median follow‐up was 59.5 months (range, 2–204). The median interval between pneumonectomy and repositioning was 13 months (range, 8–581). Two patients underwent placement of a single tissue expander, and two tissue expanders were placed in eight of the 10 patients. The median volume of tissue expanders inflated with saline was 450 cc (range, 60–850 cc) per tissue expander. There was no perioperative mortality in our study. Complications occurred in four patients (40%).ConclusionsRepositioning of the mediastinum with placement of a saline filled tissue expander for PPS is very effective for the relief of symptoms, with low mortality.

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Section: Discussionmentioning

confidence: 99%

Management of post‐pneumonectomy syndrome using tissue expanders

et al. 2015

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“…It is generally believed that PPS occurs more frequently in children and young adults because of increased mobility of the mediastinum and higher elasticity and compliance of the remaining lung, allowing hyperinflation. 3) A wide variety of treatment options have been described for these patients, ranging from simple bronchial stent insertion to aortic division and bypass grafting, in addition to mediastinal repositioning. 2,4,5) Currently, the most common approach involves a thoracotomy, mediastinal repositioning, and the insertion of saline-filled prostheses.…”

Section: Discussionmentioning

confidence: 99%

Successful Use of Mediastinal Repositioning Employing PTFE Sheet for Right-Sided Post-Pneumonectomy Syndrome

Chujo¹,

Anami²,

Kawahara

2014

ATCS

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IntroductionPost-pneumonectomy syndrome (PPS), a rare, late complication of pneumonectomy, is characterized by shift and rotation of the mediastinum to the pneumonectomy side, which leads to stretching and compression of the remaining bronchus. In the past, diverse treatments were employed. We herein present the useful technique of mediastinal repositioning using a PTFE (polytetrafluoroethylene) sheet for right-sided PPS. Case ReportThe patient was a 53-year-old female who underwent a right pneumonectomy through a thoracotomy for locally advanced squamous cell lung cancer at 51 years of age. The post-operative classification was pT2N2M0 (stage IIIA). Post-operative recovery was uneventful. However, mild dyspnea and stridor developed approximately 1 year after surgery, and her symptoms progressed. A chest roentgenogram demonstrated a right-sided mediastinal shift with signs of emphysema of the left lung (Fig. 1a) compared with the X-ray taken 1 year previously. A computed tomography (CT) scan showed the right-sided mediastinal shift (Fig. 2a). A stretched left main bronchus was markedly compressed between the descending aorta and left pulmonary artery. Under local anesthesia, a 20-mm incision in the seventh intercostal space at the right middle axillary line was made and a chest tube with a balloon Post-pneumonectomy syndrome (PPS) is a rare late complication of pneumonectomy, and diverse treatments have been employed. We herein present a useful technique for right-sided PPS. The patient was a 53-year-old female who underwent a right pneumonectomy for locally advanced squamous cell lung cancer (pT2N2M0). Mild dyspnea and stridor developed and progressed 1 year after surgery. A chest roentgenogram and computed tomography (CT) scan showed a right-sided mediastinal shift. Under local anesthesia, a chest tube with a balloon was inserted into the right thoracic cavity, and the balloon was inflated with air. Dyspnea and stridor improved and disappeared as the balloon expanded. Then, mediastinal fixation was performed under general anesthesia. Mediastinal fixation involved a PTFE (polytetrafluoroethylene) sheet which was sewn on the sternum and costal cartilage anteriorly, on the vertebra posteriorly, and covered the azygos vein level superiorly and two thirds of the pericardium inferiorly using nonabsorbable sutures. A post-operative chest roentgenogram and CT scan showed improvement of the right-sided mediastinal shift. The post-operative course was uneventful, and dyspnea and stridor were improved and became stable. In conclusion, the presented method is a useful procedure for right-sided PPS.

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“…Audry et al 5 and Rasch et al 6 reported tissue expander leakage requiring replacement. In a retrospective case series of 19 patients, Macaré van Maurik et al 7 reported four incidents of tissue expander leakage.…”

Section: Discussionmentioning

confidence: 99%