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Patel AJ, Mangel T, Perris R, El-Gamal I, Shatila M, Farooq MO, Kalkat MS. VATS surgical anatomical resection of bronchopulmonary sequestration presenting as chest sepsis. J Cardiothorac Surg 2022; 17:130. [PMID: 35619115 PMCID: PMC9137073 DOI: 10.1186/s13019-022-01887-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 05/19/2022] [Indexed: 11/10/2022] Open
Abstract
Background Bronchopulmonary sequestration (BPS) is a malformation of the lungs resulting in lung tissue lacking direct communication to the tracheobronchial tree. Most cases demonstrate systemic arterial blood supply from the descending thoracic aorta, the abdominal aorta, celiac axis or splenic artery and venous drainage via the pulmonary veins with occasional drainage into azygos vein. BPS is considered a childhood disease and accounts for 0.15–6.40% of congenital pulmonary malformations. BPS is divided into intralobar sequestrations (ILS) and extralobar sequestrations (ELS) with ILS accounting for 75% of all cases. Methods Here we present our 11-year experience of dealing with BPS; all cases presented with recurrent chest sepsis in young-late adulthood regardless of the type of pathological sequestration. The surgical technique employed was a minimally invasive video-assisted thoracoscopic anterior approach (VATS). Results Between May 2010 and September 2021, we have operated on nine adult patients with bronchopulmonary sequestration who presented late with symptoms of recurrent chest sepsis. Most patients in the cohort had lower lobe pathology, with a roughly even split between right and left sided pathology. Moreover, the majority were life-long never smokers and an equal preponderance in males and females. The majority were extralobar sequestrations (56%) with pathological features in keeping with extensive bronchopneumonia and bronchiectasis. There were no major intra-operative or indeed post-operative complications. Median length of stay was 3 days. Conclusions Dissection and division of the systemic feeding vessel was readily achievable through a successful anterior VATS approach, regardless of the type of sequestration and without the use of pre-operative coiling of embolization techniques. This approach gave excellent access to the hilar structures yet in this pathology, judicious and perhaps a lower threshold for open approach should be considered.
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Affiliation(s)
- Akshay J Patel
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, England, UK. .,Department of Thoracic Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham, UHB Hospitals NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, England, UK.
| | - Tobin Mangel
- Department of Thoracic Surgery, St. George's Hospital NHS Foundation Trust, London, England, UK
| | - Rebecca Perris
- Department of Thoracic Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham, UHB Hospitals NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, England, UK
| | - Islam El-Gamal
- Department of Thoracic Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham, UHB Hospitals NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, England, UK
| | - Mohamed Shatila
- Department of Thoracic Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham, UHB Hospitals NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, England, UK
| | - Muhammad Omar Farooq
- Department of Thoracic Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham, UHB Hospitals NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, England, UK
| | - Maninder S Kalkat
- Department of Thoracic Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham, UHB Hospitals NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, England, UK
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