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Abu Zahira I, Haddad RN, Meot M, Bonnet D, Malekzadeh-Milani S. Transcatheter Management of Pulmonary Sequestrations in Children-A Single-Center Experience. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1197. [PMID: 37508694 PMCID: PMC10378210 DOI: 10.3390/children10071197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/26/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND A pulmonary sequestration (PS) is an area of bronchopulmonary tissue with aberrant arterial supply. Transcatheter occlusion of PSs is an appealing treatment option, but data on outcomes remain scarce. We aim to describe our experience with transcatheter management of PS in infants and children. METHODS Retrospective review of clinical data of all patients with suspected PS sent for diagnostic and/or interventional cardiac catheterization at our institution between January 1999 and May 2021. Procedural considerations, techniques, standard safety, and outcomes were assessed. RESULTS We identified 71 patients (52.1% males), with median age and weight of 4.9 months (IQR, 2.1-26.6) and 4.2 kg (IQR, 3.9-12.1), respectively. Sixty-one (86%) patients had associated congenital heart defects (CHDs). Forty-two (59%) patients had pulmonary arterial hypertension (PAH) at the time of diagnosis. Fifty-three (74.7%) patients underwent embolization of the PS feeding vessel using microcoils and/or vascular plugs, and eight (15.1%) of these were neonates who presented with severe PAH and cardiac failure. Two patients had large feeding vessels and were treated surgically. Sixteen (22.5%) patients with small feeding vessels received conservative management. At median follow-up of 36.4 months (IQR, 2.1-89.9), seven patients had died, 24 patients had CHD corrective surgeries, 26 patients had redo catheterizations, and five patients had persistent PAH. No PS surgical resection was needed, and no infection of the remaining lung tissue occurred. CONCLUSIONS Transcatheter assessment and treatment of PSs is a safe and effective procedure. Neonates with large PSs are severely symptomatic and improve remarkably after PS closure. PS embolization and surgical repair of associated CHDs generally leads to the normalization of pulmonary pressures.
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Affiliation(s)
- Ibrahim Abu Zahira
- M3C-Necker, Hôpital Universitaire Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), 75015 Paris, France
| | - Raymond N Haddad
- M3C-Necker, Hôpital Universitaire Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), 75015 Paris, France
| | - Mathilde Meot
- M3C-Necker, Hôpital Universitaire Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), 75015 Paris, France
| | - Damien Bonnet
- M3C-Necker, Hôpital Universitaire Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), 75015 Paris, France
- Faculté de Médecine, Université de Paris Cité, 15 Rue de l'École de Médecine, 75006 Paris, France
| | - Sophie Malekzadeh-Milani
- M3C-Necker, Hôpital Universitaire Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), 75015 Paris, France
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Tang M, Wu X, Hu S, Wu Q, Yang D, Iroegbu CD, Fan C, Yang J. A case of rare pulmonary sequestration complicated with congenital heart disease treated by arterial embolization and atrial defect closure: A case report and review of literature. Front Cardiovasc Med 2022; 9:931590. [PMID: 35935633 PMCID: PMC9353628 DOI: 10.3389/fcvm.2022.931590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/28/2022] [Indexed: 11/18/2022] Open
Abstract
Pulmonary sequestration with congenital heart disease is a rare congenital malformation. Herein, we report a 19-month-old toddler diagnosed with right lower pulmonary sequestration, right pulmonary artery dysplasia, right lower pulmonary venous ectopic drainage, and a right-sided heart with an atrial septal defect. The pulmonary sequestration had a rare blood supply, such as confluent arteries with the renal vessels draining into the hepatic veins. Arterial embolization and atrial defect closure were used to treat the rare congenital malformation with satisfactory results.
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Affiliation(s)
- Mi Tang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xun Wu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shijun Hu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Qin Wu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Danni Yang
- Hunan Agricultural University, Changsha, China
| | - Chukwuemeka Daniel Iroegbu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Chengming Fan
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Chengming Fan,
| | - Jinfu Yang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
- Jinfu Yang,
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Debating the embolization of a large aberrant systemic artery for pulmonary sequestration using an Amplatzer duct occluder: a case report and literature review. Cardiol Young 2022; 32:331-336. [PMID: 34321118 DOI: 10.1017/s1047951121002924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Here, we report two rare cases of pulmonary sequestration that were fed by large systemic arteries and embolized with a large Amplatzer duct occluder and their 3-year follow-up, and we discuss the efficacy and safety of the embolization of a large aberrant systemic artery to pulmonary sequestration using an Amplatzer duct occluder. A 9-year-old boy complained of chest pain for 1 month, and a 6-year-old boy initially complained of recurrent cough for 3 months. A series of examinations was launched to evaluate any possible malformation or abnormalities in the patients. Chest CT and CTA identified a right lower pulmonary sequestration with infection. After admission, transcatheter device occlusion was planned after essential antibiotic treatment, and postoperative infection prevention and anti-inflammatory treatment were given. In the following 2 years of follow-up, neither of the children had recurrent chest pain, cough or other related symptoms. However, the CT follow-up demonstrated that a residual mass was visible in both patients. The same chest scan section revealed slight reductions in lung lesions from 38.344 cm2 to 37.119 cm2 (3% reduction) and 14.243 cm2 to 13.178 cm2 (7.5% reduction) for each patient. No follow-up data demonstrated the long-term clinical outcomes of the residual lesion. We do not recommend that embolization be performed for large pulmonary sequestration lesions with an aberrant artery larger than 6 mm that is planned to receive a device larger than 10 mm, as their outcomes showed a higher possibility of rebuilding the vascularization network feeding the pulmonary sequestration, indicating a higher risk for long-term complications.
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4
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Marine L, Torrealba JI, Valdes F, Mertens R, Vargas F, Bergoeing M, Vallejos D. Endovascular treatment of a right pulmonary sequestration supplied by an aneurysmal aberrant artery originating from the abdominal aorta. J Vasc Bras 2022; 21:e20190160. [PMID: 35677746 PMCID: PMC9136689 DOI: 10.1590/1677-5449.201901602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/13/2022] [Indexed: 05/31/2023] Open
Abstract
Endovascular embolization of arteries feeding pulmonary sequestrations is a growing therapeutic option. A 51-year-old woman with chest pain and hemoptysis was admitted. During hospitalization she presented 150 mL hemoptysis, hypotension, and hematocrit fell to 23.3%. Contrast-enhanced computed tomography confirmed a pulmonary sequestration irrigated by an aneurysmal artery from the abdominal aorta. The patient underwent endovascular coil embolization of the artery feeding the aneurysm and an Amplatzer device was deployed in the proximal third of the sequestration artery. Subsequent contrast-enhanced computed tomography confirmed complete thrombosis of the aberrant artery feeding the aneurysm and absence of irrigation of the pulmonary sequestration. At 56 months follow-up the patient remains asymptomatic, tomography showed involution of the sequestration and complete thrombosis of the aberrant artery. The challenges presented by the different treatment alternatives are discussed.
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Clinical Outcomes of Transarterial Embolization in the Treatment of Pulmonary Sequestration. Cardiovasc Intervent Radiol 2021; 44:1491-1496. [PMID: 34131775 DOI: 10.1007/s00270-021-02885-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/27/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To assess the safety and efficacy of transarterial embolization (TAE) for pulmonary sequestration (PS). METHODS A single-center, retrospective study was conducted from March 2013 and December 2020. Patient characteristics, laboratory/imaging, complications, and the TAE procedure were reviewed. RESULTS 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 2-4 days. 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 2 weeks and 3 months, with a clinical success rate of 90.9%. CONCLUSIONS TAE may be a feasible alternative treatment for pulmonary sequestration.
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6
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Liu Y, Yu Z, Yu P, Ito A, Gonzalez M, Hirai K, Polaczek M, Liu H. How to optimize the treatment strategy for patients of pulmonary sequestration with an elevated risk of fatal hemorrhage during operation: case discussion. J Thorac Dis 2020; 12:4450-4458. [PMID: 32944358 PMCID: PMC7475538 DOI: 10.21037/jtd-20-2059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Video-assisted thoracoscopic surgery (VATS) lobectomy, especially uniportal VATS, is increasingly used for pulmonary sequestration (PS). However, there are few descriptions of safe handling of the aberrant artery with atherosclerosis, especially the diameter of arteries exceeds than 2.0 cm, under uniportal VATS approach. Here we report a 56-year-old man who was diagnosed with pulmonary sequestration following trauma. The patient had a long history of cough with purulent sputum. One month before the trauma, he had copious expectoration with foul smell again. A contrast CT scan revealed a 7.5 cm mass in his right lower lobe. The mass was supplied by a thick aberrant atherosclerotic artery (over than 2 cm in diameter), which stemmed from the thoracic aorta with multiple calcifications on both. After adequate preoperative evaluation, we performed a right lower lobectomy under uniportal VATS approach. No surgical-associated complications occurred, and the patient was discharged on the 5th days after the operation. We organized an iMDT (international multidisciplinary team) to discuss the reasonability and optimal treatment pattern for this patient. We found that fully assess the quality of the aberrant arteries of PS following blocking and cutting off in an appropriate way are crucial to avoid the happening of fatal bleeding during the operation.
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Affiliation(s)
- Yu Liu
- Department of Thoracic Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Zhanwu Yu
- Department of Thoracic Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Pingwen Yu
- Department of Thoracic Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Atsushi Ito
- Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Mie, Japan
| | - Michel Gonzalez
- Service of Thoracic Surgery, University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland
| | - Kyoji Hirai
- Department of Thoracic Surgery, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Chiba, Japan
| | - Mateusz Polaczek
- Third Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, Warszawa, Poland
| | - Hongxu Liu
- Department of Thoracic Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital and Institute, Shenyang, China
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He B, Sun MS, Niu Y, Zhang JB, Nie QQ, Zheng X, Fan XQ, Liu P. Hybrid and Endovascular Treatment of Pulmonary Sequestration: Two Case Reports and Literature Review. Ann Vasc Surg 2020; 69:447.e1-447.e8. [PMID: 32745655 DOI: 10.1016/j.avsg.2020.06.066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/07/2020] [Accepted: 06/27/2020] [Indexed: 11/24/2022]
Abstract
Pulmonary sequestration is an uncommon congenital pulmonary anomaly associated with aberrant systemic arteries which usually originate from the thoracic aorta or abdominal aorta. Traditionally, surgical resection and ligation of the feeding vessels are the gold standard treatments of the disease. Endovascular intervention and hybrid operation are promising treatment options. However, the case reports with endovascular and hybrid treatment are sparse to our knowledge. We presented 2 symptomatic adult patients with pulmonary sequestration successfully treated by hybrid operation and transcatheter embolization, respectively. Besides, we reviewed 37 previously reported cases of pulmonary sequestration treated by endovascular or hybrid treatment.
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Affiliation(s)
- Bin He
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Ming-Sheng Sun
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Yun Niu
- Department of Pathology, China-Japan Friendship Hospital, Beijing, China
| | - Jian-Bin Zhang
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Qiang-Qiang Nie
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Xia Zheng
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Xue-Qiang Fan
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China.
| | - Peng Liu
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China.
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8
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Chen Y, Liu B, Shao J, Liu D, Zheng Y. Endovascular treatment of pulmonary sequestration with thoracic endograft: Two case reports. Medicine (Baltimore) 2019; 98:e16666. [PMID: 31374041 PMCID: PMC6708911 DOI: 10.1097/md.0000000000016666] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Pulmonary sequestration (PS) is a rare congenital lung malformation. The classical treatment of the disease has been conventional surgery with resection of abnormal parenchyma. Recently, the endovascular embolization has been proposed for the treatment of this disease. Here we present 2 cases of PS successfully treated with thoracic endograft. PATIENT CONCERNS Two patients with abnormal consolidation in the left lower lobe were admitted in our hospital. DIAGNOSIS Chest computed tomography angiography (CTA) showed abnormal consolidation in the left lower lobe, which received systemic blood supply from the descending aorta in both patients. So the diagnosis of PS was confirmed. INTERVENTIONS Endovascular treatment with thoracic endograft was successfully performed. OUTCOMES The patients recovered well and were completely free of symptoms. And the CTA follow-up showed the abnormal pulmonary parenchyma shrunk significantly. CONCLUSIONS Endovascular treatment with thoracic endograft is a promising treatment option for PS.
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Zhang SX, Wang HD, Yang K, Cheng W, Wu W. Retrospective review of the diagnosis and treatment of pulmonary sequestration in 28 patients: surgery or endovascular techniques? J Thorac Dis 2017; 9:5153-5160. [PMID: 29312721 DOI: 10.21037/jtd.2017.10.145] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background 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. Methods 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. Results 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. Conclusions 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.
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Affiliation(s)
- Shi-Xin Zhang
- Cardiothoracic Surgery Department, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Hai-Dong Wang
- Cardiothoracic Surgery Department, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Kang Yang
- Cardiothoracic Surgery Department, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Wei Cheng
- Cardiothoracic Surgery Department, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Wei Wu
- Cardiothoracic Surgery Department, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
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Zener R, Bottoni D, Zaleski A, Fortin D, Malthaner RA, Inculet RI, Mujoomdar A. Transarterial embolization of intralobar pulmonary sequestration in a young adult with hemoptysis. J Thorac Dis 2017; 9:E188-E193. [PMID: 28449501 DOI: 10.21037/jtd.2017.02.82] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Intralobar pulmonary sequestration is a rare congenital malformation characterized by the presence of dysplastic lung that does not communicate with the tracheobronchial tree, and has aberrant systemic arterial supply. While most are asymptomatic, they rarely can present with hemoptysis, which has been traditionally managed with surgical resection of the sequestration. We report a case of an 18-year-old male who presented with acute large-volume hemoptysis on a background of recurrent minor episodes of hemoptysis, due to intralobar sequestration. He was successfully treated with transarterial embolization with a combination of polyvinyl alcohol (PVA) particles, gelfoam and coils. Transarterial embolization can be effective in managing emergent hemoptysis from pulmonary sequestration.
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Affiliation(s)
- Rebecca Zener
- Department of Medical Imaging, Western University, Victoria Hospital, London Health Sciences Centre, London, Ontario N6A 5W9, Canada
| | - David Bottoni
- Division of Thoracic Surgery, Western University, Victoria Hospital, London Health Sciences Centre, London, Ontario N6A 5W9, Canada
| | - Andrew Zaleski
- Department of Medical Imaging, Western University, Victoria Hospital, London Health Sciences Centre, London, Ontario N6A 5W9, Canada
| | - Dalilah Fortin
- Division of Thoracic Surgery, Western University, Victoria Hospital, London Health Sciences Centre, London, Ontario N6A 5W9, Canada
| | - Richard A Malthaner
- Division of Thoracic Surgery, Western University, Victoria Hospital, London Health Sciences Centre, London, Ontario N6A 5W9, Canada
| | - Richard I Inculet
- Division of Thoracic Surgery, Western University, Victoria Hospital, London Health Sciences Centre, London, Ontario N6A 5W9, Canada
| | - Amol Mujoomdar
- Department of Medical Imaging, Western University, Victoria Hospital, London Health Sciences Centre, London, Ontario N6A 5W9, Canada
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Avsenik J, Štupnik T, Popovič P. Endovascular embolization prior to surgical resection of symptomatic intralobar pulmonary sequestration in an adult. Eur J Radiol Open 2015; 3:12-5. [PMID: 27069973 PMCID: PMC4811849 DOI: 10.1016/j.ejro.2015.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 11/21/2015] [Indexed: 11/12/2022] Open
Abstract
Intralobar pulmonary sequestration is a rare congenital malformation, conventionally managed by surgical resection. Recently, the endovascular embolization has been proposed for the definite treatment of this disease. Additionally, preoperative embolization of aberrant arteries to minimize the risk of serious intraoperative haemorrhage has also been described. We report the case of 43-year old female patient who presented with cough and haemoptysis, and was successfully treated with endovascular embolization followed by a Video-assisted thoracoscopic wedge resection.
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Affiliation(s)
- Jernej Avsenik
- Clinical Institute of Radiology, University Medical Centre Ljubljana, Zaloska 7, 1000 Ljubljana, Slovenia
| | - Tomaž Štupnik
- Department of Thoracic Surgery, University Medical Centre Ljubljana, Zaloska 7, 1000 Ljubljana, Slovenia
| | - Peter Popovič
- Clinical Institute of Radiology, University Medical Centre Ljubljana, Zaloska 7, 1000 Ljubljana, Slovenia
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12
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Lee JH, Kim MJ. Intradiaphragmatic extralobar pulmonary sequestration in adult. J Cardiothorac Surg 2014; 9:112. [PMID: 24950768 PMCID: PMC4075981 DOI: 10.1186/1749-8090-9-112] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 06/16/2014] [Indexed: 12/23/2022] Open
Abstract
Extralobar pulmonary sequestrations may be located in intrathoracic or extrathoracic areas. Extrathoracic intradiaphragmatic extralobar pulmonary sequestrations are an extremely rare subset of bronchopulmonary sequestrations and there have been very few reported cases until now. We describe a 48-year-old Korean woman found to have left peridiaphragmatic lesion on computed tomography. We performed thoracoscopic surgery and successfully resected the tumor. Based on the histological findings, it was diagnosed as an intradiaphragmatic extralobar pulmonary sequestration. Postoperative course was uneventful. Intradiaphragmatic extralobar pulmonary sequestration in adult is extremely rare, so we report the case with a literature review.
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Affiliation(s)
- Jang-Hoon Lee
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Yeungnam University, Daemyeong 5-dong, Nam-gu, Daegu Zip code 705-717, Korea.
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13
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Assessment of 64-row computed tomographic angiography for diagnosis and pretreatment planning in pulmonary sequestration. Radiol Med 2013; 119:27-32. [DOI: 10.1007/s11547-013-0304-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Accepted: 09/25/2012] [Indexed: 01/28/2023]
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14
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An unusual left upper quadrant mass: a bronchopulmonary foregut malformation. Case Rep Surg 2013; 2013:740292. [PMID: 23533917 PMCID: PMC3600227 DOI: 10.1155/2013/740292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 01/29/2013] [Indexed: 12/05/2022] Open
Abstract
We report a case of a lady who presented with epigastric discomfort. Physical examination revealed a large left upper quadrant mass filling the left upper quadrant. Following extensive preoperative evaluation, she underwent resection of this 9 × 10 × 11 centimeter mass with en bloc excision of a portion of the left hemidiaphragm. She made an uneventful postoperative recovery. Histopathology revealed a bronchopulmonary foregut malformation with pulmonary sequestration. This developmental anomaly of the foregut typically occurs in the thoracic cavity; however, it can occur below the diaphragm. Herein we report a case and a detailed review of the embryology, clinical features, and management of these extremely rare clinical entities.
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15
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Cho MJ, Kim DY, Kim SC, Kim KS, Kim EAR, Lee BS. Embolization versus surgical resection of pulmonary sequestration: clinical experiences with a thoracoscopic approach. J Pediatr Surg 2012; 47:2228-33. [PMID: 23217881 DOI: 10.1016/j.jpedsurg.2012.09.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 09/01/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE The goal of this study was to compare the safety and efficacy of treatment for pulmonary sequestration (PS) by transcatheter arterial embolization (TAE) versus surgical resection and to consider the role of a thoracoscopic approach. METHODS A retrospective review involving 73 children (≤ 15 years of age) with PS between 2002 and 2011 was performed. RESULTS Forty-two patients were managed with TAE, and 31 underwent surgery alone. Their presenting symptoms were pneumonia (n=11), pneumothorax (n=2), pneumomediastinum (n=1) and respiratory distress (n=6).Fifty-three (72.6%) were asymptomatic. The average age at treatment was 17.0 ± 44.4 and 31.3 ± 41.7 months for the TAE and surgery groups, respectively. In the TAE group, complete regression was observed in only 3 patients, 4 showed no regression, and 35 (83.3%) had residual lesions. Four patients developed sepsis or other blood vessel complications after TAE. The results of resection via thoracotomy versus a thoracoscopic approach were evaluated in 34 patients, including 3 who underwent the operation after TAE. Twenty-seven patients underwent thoracotomy, and 7 underwent thoracoscopic resection. There were no significant differences between the groups except time to chest tube removal, which was shorter in the thoracoscopic group (p=0.046). Complications included a wound infection in 1 patient after thoracotomy. CONCLUSIONS We believe that even in asymptomatic patients, all PSs should be resected because of the risk of infection, the low rate of natural regression, complications after TAE, and to exclude other pathology. Our experience also shows that thoracoscopic resection of PS is feasible, efficacious, and safe in newborns and infants.
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Affiliation(s)
- Min Jeng Cho
- Division of Surgery, Konkuk University Medical Center, Seoul, Korea
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16
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[Endovascular treatment of pulmonary sequestration with Amplatzer® vascular plugs]. An Pediatr (Barc) 2011; 76:285-9. [PMID: 22197738 DOI: 10.1016/j.anpedi.2011.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 10/23/2011] [Accepted: 11/07/2011] [Indexed: 11/20/2022] Open
Abstract
Pulmonary sequestration is a rare malformation characterised by non-functioning lung tissue, separated from the tracheobronchial tree and with arterial supply from the systemic circulation. The classical therapeutic approach is surgical resection. In recent years, the endovascular embolisation technique is increasingly being used for the treatment of this disease. The embolisation materials used are coils and vascular plugs. The Amplatzer® vascular plug is a self-expandable cylindrical mesh device, particularly useful for the embolisation of large vessels with high flow. Three cases of pulmonary sequestration were treated by embolisation with Amplatzer® vascular plugs. In all cases the procedure was performed without complications, and the aortopulmonary collateral vessels were completely occluded. Our study provides new data on the safety and efficacy of pulmonary embolisation with Amplatzer® vascular plugs, and its preference over coils in the embolisation of large vessels.
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Treatment of pulmonary sequestrations by means of endovascular embolization: future or fashion? Case Rep Med 2011; 2011:173918. [PMID: 21961010 PMCID: PMC3179888 DOI: 10.1155/2011/173918] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Accepted: 08/01/2011] [Indexed: 12/02/2022] Open
Abstract
Bronchopulmonary sequestration is a rare malformation of the lower
respiratory tract. Several methods of treatment have been described since the first publication. We present two cases of female adult patients with
bronchopulmonary sequestration. In the first patient an unsuccessful attempt to treat the bronchopulmonary sequestration by means of arterial embolization
is described. She was subsequently treated by means of surgical resection, which was the primary treatment for the second patient. Although endovascular techniques are becoming promising, in our opinion surgical resection remains the unique treatment for bronchopulmonary sequestration.
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Castaldi B, Santoro G, Gaio G, Palladino MT, Russo MG, Calabrò R. Percutaneous embolization of lung sequestration using a novel occluding device. J Cardiovasc Med (Hagerstown) 2011; 12:349-50. [DOI: 10.2459/jcm.0b013e3283403789] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ganeshan A, Freedman J, Hoey ETD, Steyn R, Henderson J, Crowe PM. Transcatheter coil embolisation: a novel definitive treatment option for intralobar pulmonary sequestration. Heart Lung Circ 2010; 19:561-5. [PMID: 20542467 DOI: 10.1016/j.hlc.2010.05.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Accepted: 05/10/2010] [Indexed: 01/15/2023]
Abstract
Pulmonary sequestrations have been conventionally treated surgically with removal of the tissue mass and ligation of its feeding vessels. There is established evidence to support the use of transcatheter arterial coil embolisation as an effective definitive treatment option for extralobar sequestration especially in the paediatric literature describing good long-term clinical outcomes. We present a case of an adult with intralobar sequestration in whom the diagnosis was established with multi-detector computed tomography (MDCT) and in whom transcatheter arterial coil embolisation was successfully performed as a definitive treatment option to support the growing body of evidence of transcatheter arterial coil embolisation as a safe and effective treatment option for both form of pulmonary sequestrations.
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Affiliation(s)
- A Ganeshan
- Cardiovascular and Interventional Radiology, Heart of England NHS Foundation Trust, Birmingham, UK.
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20
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Intradiaphragmatic extralobar sequestration-a rare pulmonary anomaly. J Pediatr Surg 2009; 44:e27-9. [PMID: 20006001 DOI: 10.1016/j.jpedsurg.2009.09.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2009] [Revised: 09/21/2009] [Accepted: 09/23/2009] [Indexed: 11/22/2022]
Abstract
Extralobar pulmonary sequestrations are most commonly found within the thoracic cavity, but have been described within the abdomen. We present the case of a 16-month-old boy with an intradiaphragmatic pulmonary sequestration and demonstrate a computed tomographic scan finding that might help identify this extremely rare abnormality preoperatively.
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21
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Chien KJ, Huang TC, Lin CC, Lee CL, Hsieh KS, Weng KP. Early and late outcomes of coil embolization of pulmonary sequestration in children. Circ J 2009; 73:938-42. [PMID: 19276609 DOI: 10.1253/circj.cj-08-0914] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Pulmonary sequestration (PS) is characterized by non-functioning lung tissue fed from 1 or several aberrant systemic arteries. The classical therapeutic approach is surgical resection. Several case reports have shown that coil embolization is feasible, but this technique has not been evaluated in a larger series of consecutively treated patients. The purpose of our study was to assess the early and long-term outcomes of coil embolization of PS in children and to determine the risk factors of early and late major adverse cardiovascular and pulmonary events. METHODS AND RESULTS Between March 1999 and December 2004, 6 patients (2 boys, 4 girls, mean age 4.7 +/-3.8 years) with PS were treated by coil embolization of the feeding systemic artery. Four patients were considered to have been cured and 2 patients required a second coil embolization 6 months later because of residual systemic flow seen on computed tomography. Transient ischemic change of the lower limb occurred in the youngest patient. None of the other patients had any late complications or recurrent pneumonia. CONCLUSIONS Coil embolization of PS is safe and feasible, with a good late outcome.
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Affiliation(s)
- Kuang-Jen Chien
- Department of Pediatrics, Kaohsiung Veterans General Hospital, National Yang-Ming University, Kaohsiung, Taiwan
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22
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Lee BS, Kim JT, Kim EAR, Kim KS, Pi SY, Sung KB, Yoon CH, Goo HW. Neonatal pulmonary sequestration: clinical experience with transumbilical arterial embolization. Pediatr Pulmonol 2008; 43:404-13. [PMID: 18302235 DOI: 10.1002/ppul.20799] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Pulmonary sequestration (PS) is a rare congenital malformation of the lower respiratory tract. The exact natural course of PS is not well understood and there are no well-established treatment guidelines for antenatally diagnosed PS. The aim of this study was to describe clinical outcomes in neonates with PS and to evaluate the efficacy of transumbilical arterial embolization (TUE). From 1998 to 2006, total 30 neonatal cases were included. Serial antenatal ultrasound in 26 cases found 6 (23%) regressed lesions, all of which were demonstrated on postnatal chest CT. Six (20%) cases were classified as mixed-type (combined cystic) lesions. Surgery was performed early (during initial hospitalization) in two cases and lately (after the neonatal period) in four cases. TUE was performed for 17 (57%) cases of intrapulmonary PS. Follow-up images obtained a median of 19 months (range, 4-51) after TUE demonstrated complete (9, 53%), partial (5, 29%), and no (3, 18%) regression. The regression rate was significantly higher in solid-type lesions (13/13, 100%) than in mixed-type (1/4, 25%) (P = 0.006). Complications included transient hypertension (two cases, 12%), post-embolization fever (two cases, 12%) and migration of a microcoil (one case, 6%), without long-term morbidities. Natural courses could be observed in 10 cases of extralobar PS and regression was observed in 2 cases (20%) during a median follow-up of 12 months (range, 6-45). A well-designed comparative study is warranted to evaluate the long-term efficacy and safety of TUE.
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Affiliation(s)
- Byong Sop Lee
- Department of Pediatrics, Division of Neonatology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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23
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Kitano Y, Sago H, Hayashi S, Kuroda T, Honna T, Morikawa N. Aberrant Venous Flow Measurement May Predict the Clinical Behavior of a Fetal Extralobar Pulmonary Sequestration. Fetal Diagn Ther 2008; 23:299-302. [DOI: 10.1159/000123617] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Accepted: 02/26/2007] [Indexed: 11/19/2022]
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24
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Kitano Y, Matsuoka K, Honna T, Kuroda T, Morikawa N, Hayashi S, Sago H. Venous arterialization in extralobar pulmonary sequestration associated with fetal hydrops. J Pediatr Surg 2006; 41:490-4. [PMID: 16516622 DOI: 10.1016/j.jpedsurg.2005.10.080] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND/PURPOSE Fetal extralobar pulmonary sequestration (EPS) is sometimes complicated by massive pleural effusion (PE) leading to fetal hydrops. The underlying mechanisms as well as the origin of the fluid are not well understood. This study was performed to find a histological hallmark of an EPS with massive PE. We hypothesized that venous obstruction has a role to play in the mechanisms of fluid production by EPS. METHODS We recently experienced 3 cases of fetal EPS complicated by fetal hydrothorax requiring thoracentesis and eventually thoracoamniotic shunt placement. Total protein content and cell count were measured in the aspirates, which were compared with chylothorax cases (n = 5) requiring fetal shunt placement. After birth, all 3 infants required mass resection for the control of PE. The venous wall thickness was measured on pathology slides stained with Elastica van Gieson staining. Thickness of the media and adventitia was measured in approximately 40 veins per case. They were corrected by external diameter and expressed as percentage of medial thickness and percentage of adventitial thickness. An EPS not associated with PE but with congenital diaphragmatic hernia served as a control. RESULTS Total protein and the cell count of the EPS related PE were 0.6 +/- 0.3 mg/dL and 28 +/- 14/microL (mean +/- SD), which were significantly lower than those of PE in chylothorax (2.2 +/- 0.2 mg/dL and 1900 +/- 1100/microL). Percentages of adventitial thickness of EPS with PE were 9.8% +/- 3.8%, 10.4% +/- 3.6%, and 8.3% +/- 3.7%, which were significantly increased compared with the control of 3.1% +/- 1.3% (P < .01). Percentages of medial thickness of EPS with PE were 7.0% +/- 1.9%, 7.3% +/- 1.4%, and 6.6% +/- 2.3%, which were significantly increased compared with the control of 2.3% +/- 0.7% (P < .01). CONCLUSIONS We conclude that PE associated with EPS is the transudate rather than the lymph. The thickened media and the adventitia found in EPS with PE support the hypothesis that partial obstruction of the venous system leads to an increased transudate production, which ultimately leads to fetal hydrops.
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Affiliation(s)
- Yoshihiro Kitano
- Division of General Surgery, National Center for Child Health and Development, Setagaya-ku, Tokyo 157-8535, Japan.
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25
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Nayar PM, Thakral CL, Sajwani MJ. Congenital lobar emphysema and sequestration--treatment by embolization. Pediatr Surg Int 2005; 21:727-9. [PMID: 15995872 DOI: 10.1007/s00383-005-1462-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2004] [Indexed: 01/09/2023]
Abstract
A case of congenital lobar emphysema associated with pulmonary sequestration, presenting with respiratory distress in infancy, is reported. The lobar hyperinflation was managed by emergency lobectomy. The ipsilateral lower lobe affected with vascular sequestration was salvaged by therapeutic embolization, thus avoiding the long-term sequelae of pneumonectomy. The case is reported for its rarity.
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Affiliation(s)
- P M Nayar
- Department of Pediatric Surgery, Royal Hospital, PO1331, 111 Muscat, Sultanate of Oman.
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26
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Abstract
Pulmonary sequestration refers to the situation whereby a portion of lung tissue receives its blood supply from an anomalous systemic artery. Three main variants exist: intralobar, extralobar and communicating bronchopulmonary foregut malformations. Venous drainage is typically via a systemic vein, although drainage into the pulmonary veins is well documented. Pulmonary sequestrations are the second commonest congenital lung anomaly. Affected individuals often have other anomalies which are responsible for most of the mortality associated with sequestrations. Diagnosis requires a high index of suspicion particularly in any child with a chest x-ray suggesting the presence of a mass, those with recurrent chest infections and those with other anomalies seen with the pulmonary sequestration spectrum. Surgical excision is usually advised, although embolisation of the feeding vessel has a role in selected cases.
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Affiliation(s)
- Harriet J Corbett
- Royal Manchester Children's Hospital, Hospital Road, Pendlebury, Manchester, UK
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27
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Sim JY, Alejos JC, Moore JW. Techniques and applications of transcatheter embolization procedures in pediatric cardiology. J Interv Cardiol 2003; 16:425-48. [PMID: 14603802 DOI: 10.1046/j.1540-8183.2003.01009.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Transcatheter embolization of congenital or acquired superfluous vascular structure has become routine procedures performed by interventional pediatric cardiologists. Embolization procedure is often part of a collaborative effort with cardiac surgeons to palliate complex congenital heart defect, such as in embolizing aortopulmonary collateral arteries in patient with single ventricle physiology. In other cases, the procedure is the definitive treatment as in embolizing coronary artery fistula. Pediatric cardiologists performing embolization procedures should be familiar with available technologies as well as understand the underlying cardiac anatomy and pathophysiology. This article provides a comprehensive review of presently available embolization agents and technologies. Some of the technologies are used only by interventional radiologists but may be useful to pediatric cardiologists. Specific clinical applications in pediatric cardiology are also discussed with summary of current literature. With continue advancement in transcatheter technology and operator expertise, all unwanted vascular communication should be amenable to transcatheter embolization.
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Affiliation(s)
- James Y Sim
- Division of Pediatric Cardiology, Mattel Children's Hospital, UCLA, David Geffen School of Medicine, Los Angeles, California, 90095-1743, USA
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28
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Horak E, Bodner J, Gassner I, Schmid T, Simma B, Grässl G, Sawyer SM. Congenital cystic lung disease: diagnostic and therapeutic considerations. Clin Pediatr (Phila) 2003; 42:251-61. [PMID: 12739924 DOI: 10.1177/000992280304200309] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Congenital lung cysts such as congenital cystic adenomatoid malformation, pulmonary sequestration, congenital lobar emphysema, and bronchogenic cysts are rare but fascinating anomalies of lung development. While there are many similarities in terms of their presenting features, there are particular differences between the diagnostic groups that are important to highlight, especially in relationship to approaches to imaging and long-term outcome. A case of each entity is presented with an emphasis on the contemporary approach to diagnostic investigations and therapeutic options.
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Affiliation(s)
- Elisabeth Horak
- University Hospital for Children and Adolescents, A-6020 Innsbruck, Anichstr.35, Austria
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29
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Lee KH, Sung KB, Yoon HK, Ko GY, Yoon CH, Goo HW, Kim EAR, Kim KS, Pi SY. Transcatheter arterial embolization of pulmonary sequestration in neonates: long-term follow-up results. J Vasc Interv Radiol 2003; 14:363-7. [PMID: 12631642 DOI: 10.1097/01.rvi.0000058412.01661.f0] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
The purposes of this study are to describe experience with the safety and long-term efficacy of transcatheter arterial embolization (TAE) of pulmonary sequestration in neonates and to introduce a new technique of embolization by an umbilical-artery route. TAE was performed in five neonates, via the femoral artery in one and the umbilical artery in four. Complete regression was achieved in four cases and partial regression (>90%) was obtained in one. TAE is a safe and effective alternative therapeutic modality for the treatment of pulmonary sequestration. The umbilical artery represents a preferable route for performing embolization in neonates.
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Affiliation(s)
- Kwang-Hun Lee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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30
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Affiliation(s)
- Claire Langston
- Department of Pathology, Texas Children's Hospital, Houston, TX 77030, USA
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31
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Crushell E, Saidi A, al-Hassan A, Walsh K. Occlusion of an aberrant artery to a pulmonary sequestration using a duct occluder. J Interv Cardiol 2002; 15:415-6. [PMID: 12440188 DOI: 10.1111/j.1540-8183.2002.tb01078.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
This report describes a female infant with a rare chromosome defect, del. 12 (q22-24.1), who has severe pulmonary valve stenosis, an atrial septal defect, and a small muscular ventricular septal defect. At 4 months of age a balloon pulmonary valvuloplasty was performed in the cardiac catheterization laboratory. During the procedure, a large aberrant artery from the aorta to a sequestration of the right lower lobe of lung was found. The flow-off from the sequestration was into a dilated left atrium. The single artery supplying the sequestration was successfully occluded using an Amplatzer Duct Occluder device. There were no complications and the infant remains well at 1-year follow-up.
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Affiliation(s)
- Ellen Crushell
- Department of Cardiology, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland.
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Bratu I, Flageole H, Chen MF, Di Lorenzo M, Yazbeck S, Laberge JM. The multiple facets of pulmonary sequestration. J Pediatr Surg 2001; 36:784-90. [PMID: 11329590 DOI: 10.1053/jpsu.2001.22961] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE The goal of this study was to identify the proportion of sequestrations that were atypical or associated with other entities, such as congenital cystic adenomatoid malformations, communicating bronchopulmonary foregut malformations, bronchogenic cyst, and scimitar syndrome. METHODS All charts of patients with pulmonary sequestration admitted at 2 children's hospitals from 1982 to July 1999 were reviewed retrospectively. The authors included all anomalies with a systemic arterial supply or without bronchial connection. RESULTS Only 22 of the 39 patients (56%) had a classic isolated extralobar or intralobar sequestration, whereas the others presented with a spectrum of anomalies. Of the 13 cases diagnosed prenatally, 85% were asymptomatic at birth. In contrast, 26 cases diagnosed postnatally were all symptomatic, with those patients less than 2 weeks old presenting with various degrees of respiratory distress, and those older than 2 weeks old presenting with respiratory infections. The correct diagnosis was made preoperatively in 59% of cases. Only 4 patients did not undergo resection of their lesion, of which, 1 underwent interventional radiology with embolization of the anomalous arterial supply. Follow-up issues of importance included pneumonia, asthma, gastroesophageal reflux, and pectus excavatum. CONCLUSIONS Sequestrations represent a spectrum of anomalies that overlap with other lung lesions. To facilitate management, they should be described according to their (1) connection to the tracheobronchial tree, (2) visceral pleura, (3) arterial supply, (4) venous drainage, (5) foregut communication, (6) histology, (7) mixed/multiple lesions, and (8) whether there are associated anomalies. Surgeons should be aware that approximately 50% of sequestrations could be atypical or associated with other anomalies. This should be kept in mind when weighing the benefits of resection versus conservative management of pulmonary sequestrations.
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Affiliation(s)
- I Bratu
- Divisions of Pediatric Surgery and Pediatric Pathology, The Montreal Children's Hospital and Ste Justine Hospital, McGill University and University of Montreal, Montreal, Quebec, Canada
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Tokel K, Boyvat F, Varan B. Coil embolization of pulmonary sequestration in two infants: a safe alternative to surgery. AJR Am J Roentgenol 2000; 175:993-5. [PMID: 11000150 DOI: 10.2214/ajr.175.4.1750993] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- K Tokel
- Department of Pediatric Cardiology, Başkent University Faculty of Medicine, 12. sokak 7/7, Bahçelievler 06490, Ankara, Turkey
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