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Morbidity after elective resection of prenatally diagnosed asymptomatic congenital pulmonary airway malformations

Morbidity after elective resection of prenatally diagnosed asymptomatic congenital pulmonary airway malformations
Morbidity after elective resection of prenatally diagnosed asymptomatic congenital pulmonary airway malformations
Background/Aim
The optimal management of prenatally diagnosed asymptomatic congenital pulmonary airway malformations (CPAM) is controversial. Since there is a paucity of data relating to surgical risks in this specific population, we reviewed our experience to further inform this controversy.

Methods
Ethically approved 10 year (2004–2013) retrospective review. Patients were included only if the CPAM was diagnosed prenatally and remained asymptomatic. Indication for surgery was physician recommendation and/or parental choice.

Main results
Sixty patients were identified. Median age at surgery was 6.5 months (range 65 days to 9.6 years). Resections were performed thoracoscopically (n = 51, one conversion) or by thoracotomy (n = 9). Surgical time was 2.5 hr (43 min to 4.75 hr). A chest drain was used in 58/60 and remained in situ 53 hr (23–108). There were no intra‐operative complications or blood transfusions. All patients were extubated at the end of the procedure with no re‐intubations. Post‐operative hospitalization was 73.4 hr (23.8 hr to 4.2 days). Overall, complications occurred in 14/60 (23%). Eleven were minor but three were major: tension pneumothorax associated with new presentation of a small previously undiagnosed diaphragmatic hernia 5 days following resection; aggressive fibromatosis of the chest wall in the region close to resection 2 years later; and near‐fatal hypovolemic cardiac arrest due to massive haemorrhage from a feeding vessel on postoperative day 7. There were no deaths and no cases of pleuropulmonary blastoma.

Conclusion
Resection of prenatally diagnosed asymptomatic CPAM is associated with a significant risk of complications, which may be life threatening. These data contribute to a balanced discussion of risks and benefits for these children.
8755-6863
525-530
Hall, Nigel J.
6919e8af-3890-42c1-98a7-c110791957cf
Chiu, Priscilla P.L.
a38dfa31-212d-4ffb-a8b0-256e94babae4
Langer, Jacob C.
f2b7aeb2-f1a8-4475-b4e8-1a8e31eb1923
Hall, Nigel J.
6919e8af-3890-42c1-98a7-c110791957cf
Chiu, Priscilla P.L.
a38dfa31-212d-4ffb-a8b0-256e94babae4
Langer, Jacob C.
f2b7aeb2-f1a8-4475-b4e8-1a8e31eb1923

Hall, Nigel J., Chiu, Priscilla P.L. and Langer, Jacob C. (2016) Morbidity after elective resection of prenatally diagnosed asymptomatic congenital pulmonary airway malformations. Pediatric Pulmonology, 51 (5), 525-530. (doi:10.1002/ppul.23255).

Record type: Article

Abstract

Background/Aim
The optimal management of prenatally diagnosed asymptomatic congenital pulmonary airway malformations (CPAM) is controversial. Since there is a paucity of data relating to surgical risks in this specific population, we reviewed our experience to further inform this controversy.

Methods
Ethically approved 10 year (2004–2013) retrospective review. Patients were included only if the CPAM was diagnosed prenatally and remained asymptomatic. Indication for surgery was physician recommendation and/or parental choice.

Main results
Sixty patients were identified. Median age at surgery was 6.5 months (range 65 days to 9.6 years). Resections were performed thoracoscopically (n = 51, one conversion) or by thoracotomy (n = 9). Surgical time was 2.5 hr (43 min to 4.75 hr). A chest drain was used in 58/60 and remained in situ 53 hr (23–108). There were no intra‐operative complications or blood transfusions. All patients were extubated at the end of the procedure with no re‐intubations. Post‐operative hospitalization was 73.4 hr (23.8 hr to 4.2 days). Overall, complications occurred in 14/60 (23%). Eleven were minor but three were major: tension pneumothorax associated with new presentation of a small previously undiagnosed diaphragmatic hernia 5 days following resection; aggressive fibromatosis of the chest wall in the region close to resection 2 years later; and near‐fatal hypovolemic cardiac arrest due to massive haemorrhage from a feeding vessel on postoperative day 7. There were no deaths and no cases of pleuropulmonary blastoma.

Conclusion
Resection of prenatally diagnosed asymptomatic CPAM is associated with a significant risk of complications, which may be life threatening. These data contribute to a balanced discussion of risks and benefits for these children.

Text
CPAM study CPM paper Toronto PPulm Hall PP final - Accepted Manuscript
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More information

Accepted/In Press date: 22 June 2015
e-pub ahead of print date: 29 July 2015
Published date: May 2016
Organisations: Human Development & Health

Identifiers

Local EPrints ID: 378475
URI: http://eprints.soton.ac.uk/id/eprint/378475
ISSN: 8755-6863
PURE UUID: 4f0837ed-393f-47eb-93ff-fecc28d9d00b
ORCID for Nigel J. Hall: ORCID iD orcid.org/0000-0001-8570-9374

Catalogue record

Date deposited: 06 Jul 2015 10:30
Last modified: 17 Dec 2019 01:40

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