Nitinol stent insertion for post-pneumonectomy syndrome

Harney, Michael; Lacy, Peter D.; O’Neill, Shane; Walsh, Michael

doi:10.1258/0022215011909431

Cited by 16 publications

(9 citation statements)

References 6 publications

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“…Division of the ligamentum arteriosum, fixation of the aorta or pulmonary artery to the sternum, and placement of expandable stents have been described with varying outcomes. 7,[17][18][19][20] However, endoscopic bronchial stent insertion does not always enable adequate placement of a stent, and is usually applied in the presence of gross distortion. Moreover, with this treatment, the cause of compression of the main bronchus does not affect mediastinal displacement.…”

Section: Discussionmentioning

confidence: 99%

“…Without treatment, PPS can be life threatening and the treatment options are very limited. Most of the previously reported cases were single case reports; a small series described up to 20 patients …”

Section: Discussionmentioning

confidence: 99%

“…Treatment options include conservative management and surgery. Division of the ligamentum arteriosum, fixation of the aorta or pulmonary artery to the sternum, and placement of expandable stents have been described with varying outcomes . However, endoscopic bronchial stent insertion does not always enable adequate placement of a stent, and is usually applied in the presence of gross distortion.…”

Section: Discussionmentioning

confidence: 99%

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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%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Management of post‐pneumonectomy syndrome using tissue expanders

et al. 2015

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“…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. 2,4) In regard to bronchial stenting, consideration should be given to the possibility of future stent migration or erosion.…”

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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“…5 Un tratamiento alternativo consiste en la colocación broncoscópica de un tutor endobronquial; no obstante, el resultado a largo plazo y la tasa de complicaciones poscolocación continúan siendo desconocidos. 7 En quienes el tratamiento endoluminal con dispositivos fracasó o no se pudo realizar el reposicionamiento mediastinal, la división aórtica y el presente (bypass) con injerto han sido utilizadas con resultados variables.…”

Section: Síndrome Postneumonectomía Derecha: Informe De Un Casounclassified

Síndrome postneumonectomía derecha: informe de un caso

et al. 2012

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Presentación de casos clínicos RESUMENEl síndrome postneumonectomía es una entidad poco frecuente en pediatría. Comunicamos un caso secundario a una neumonectomía realizada por un tumor intratorácico. Niño de 4 años con antecedente de exéresis pulmonar derecha y dificultad respiratoria progresiva, con obstrucción extrínseca de la vía aérea por estructuras mediastínicas desplazadas. Hubo intentos frustros de tutorización con dispositivos endoluminales de la vía aérea, e imposibilidad de retiro de la asistencia ventilatoria mecánica. Ante la imposibilidad de reposicionamiento mediastinal, se realiza puente (bypass) aórtico con tubo protésico, con evolución favorable y egreso hospitalario. Palabras clave: síndrome postneumonectomía, bypass aórtico, neumonectomía. ABSTRACTPostpneumonectomy syndrome is a rare entity in children. We report a case secondary to pneumonectomy performed due to an intrathoracic tumor. A 4-year-old boy with a history of right pneumonectomy and progressive respiratory distress, with extrinsic airway obstruction due to displaced mediastinal structures. There were failure to intubate the airway with endoluminal devices and impossibility of withdrawing from mechanical ventilation. As mediastinal repositioning was not possible, an aortic bypass with a prosthetic tube graft was performed, with favorable outcome and hospital discharge.http://dx.doi.org/10.5546/aap.2012.e114 INTRODUCCIÓNEl síndrome postneumonectomía (SPN) es una rara complicación que ocurre después de resecar un pulmón. Se produce debido a la herniación del pulmón remanente y del contenido mediastí-nico en el espacio torácico vacío; existe desplazamiento y rotación de las estructuras anatómicas del mediastino. La tráquea distal se desplaza, los bronquios primarios o los bronquios del lóbulo inferior resultan elongados y comprimidos entre la arteria pulmonar por delante y la aorta o la columna por detrás.1-3 Como consecuencia de esta compresión extrínseca, el paciente presenta disnea grave y progresiva, y el cuadro puede conducir a una malacia secundaria de los cartílagos de la vía aérea.El SPN fue inicialmente descrito exclusivamente después de la neumonectomía del lado derecho, pero se han comunicado casos después de una neumonectomía izquierda con arcos aórticos derechos y sin ellos. 4,5 El síndrome ocurre en todos los grupos etarios, pero es más común en niños y adultos jóvenes. 2A través de los años se han comunicado diferentes alternativas de tratamiento. Se ha intentado el reposicionamiento mediastinal para que la formación de tejido cicatrizal prevenga una recidiva.2 Las tasas más bajas de recidiva se alcanzaron cuando el reposicionamiento mediastinal fue mejorado con la colocación de un dispositivo protésico en el espacio postneumonectomía para prevenir la recurrencia.2,3,6 Además, los síntomas obstructivos pueden persistir después del reposicionamiento mediastinal en casos de malacia. 5Un tratamiento alternativo consiste en la colocación broncoscópica de un tutor endobronquial; no obstante, el resultado a largo plazo y la ...

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Nitinol stent insertion for post-pneumonectomy syndrome

Cited by 16 publications

References 6 publications

Management of post‐pneumonectomy syndrome using tissue expanders

Management of post‐pneumonectomy syndrome using tissue expanders

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

Síndrome postneumonectomía derecha: informe de un caso

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