Lung Volume Reduction Surgery for Respiratory Failure in Infants With Bronchopulmonary Dysplasia

Abstract

Lung volume reduction surgery (LVRS) can be performed in patients with severe emphysematous disease. However, LVRS in pediatric patients has not yet been reported. Here, we report our experience with 2 cases of pediatric LVRS. The first patient was a preterm infant girl with severe bronchopulmonary dysplasia, pulmonary hypertension, and hypothyroidism. The emphysematous portion of the right lung was removed via sternotomy and right hemiclamshell incision. The patient was discharged on full-time home ventilator support for 3 months after the surgery. Since then, her respiratory function has improved continuously. She no longer needs oxygen supplementation or ventilator care. Her T-cannula was removed recently. The second patient was also a preterm infant girl with bronchopulmonary dysplasia. She was born with pulmonary hypertension and multiple congenital anomalies, including an atrial septal defect. Despite receiving the best supportive care, she could not be taken off the mechanical ventilator because of severe hypercapnia. We performed LVRS on the right lung via thoracotomy. She was successfully weaned off the mechanical ventilator 1 month after the surgery. She was discharged without severe complications at 3 months after the operation. At present, she is growing well with the help of intermittent home ventilator support. She can now tolerate an oral diet. Our experience shows that LVRS can be considered as a treatment option for pediatric patients with severe emphysematous lung. It is especially helpful for discontinuing prolonged mechanical ventilator care for patients with respiratory failure.

Hemi-Clamshell Approach for Fetal Lung Interstitial Tumor Resection in a Neonate: A Case Report

“…1 However, the use of a hemi-clamshell approach in neonates has not been previously reported, nor has the incidence of complications in pediatric patients been evaluated. 3 The diagnosis of the mass in our patient was difficult at first due to the absence of remarkable features on the first preoperative CT image. This is why we first suspected other primary lung tumor of neonates or a mediastinal tumor.…”

“… 1 However, the use of a hemi-clamshell approach in neonates has not been previously reported, nor has the incidence of complications in pediatric patients been evaluated. 3 …”

Application of lung volume reduction surgery for a child with filamin A (FLNA) mutations

“…Lung volume reduction surgery has been utilized in selected adults with lung disease. It has also been reported in case reports of infants with good results 17–20 . In the series of 26 individuals with FLNA pathogenic variants collected by Pelizzo, outcomes included end‐stage respiratory failure in at least 12 (lung transplantation in six and death in six) 7 .…”

“…It has also been reported in case reports of infants with good results. [17][18][19][20] In the series of 26 individuals with FLNA pathogenic variants collected by Pelizzo, outcomes included end-stage respiratory failure in at least 12 (lung transplantation in six and death in six). 7 Five patients survived in a limited timeframe of early childhood without intervention but there was no meaningful clinical information provided in the review.…”

The Case for the Case Report

“…Treatments are offered to improve bronchopulmonary dysplasia with lung reduction surgery, 10 to manage the consequences of an ATP1A2 gene mutation with an N-methyl-Daspartate receptor antagonist, 11 to treat neonatal hyperglycemia with insulin glargine, 12 and to improve intestinal pseudo-obstruction with pyridostigmine. 13 The authors of 3 other articles suggest a novel treatment of the erythroderma of Omenn Syndrome 14 and discuss vagal maneuver termination of ventricular tachycardia 15 and an approach to recanalizing a central vein in a total parental nutrition-dependent child with lost intravenous access.…”