Antenatally Detected Congenital Pulmonary Airway Malformations: The Oxford Experience

Eur J Pediatr Surg DOI: 10.1055/s-0036-1593379Congenital airway pulmonary malformations are increasingly being diagnosed, but their management continues to remain controversial. Our approach has been to offer surgery to mitigate the risk of infection and possible malignancy. All patients routinely undergo a CT scan of the chest postnatally and once the diagnosis is confirmed, minimal access surgery is offered. Our anesthetists provide single-lung ventilation to enhance the operative view. We conducted a retrospective review over a 10-year period, during which 91 patients were prenatally suspected to have a cystic lung lesion. There were 88 live births of which 29 (33%) cases were initially managed conservatively based on CT findings. Five of these patients, however, became symptomatic needing surgery. A total of 64 (73%) patients underwent surgery with the most common lesions being congenital pulmonary airway malformations (CPAMs) (24), hybrid lesions (19), and pulmonary sequestrations (12). The median age at surgery was 5 months (1 day to 17 months). Using a minimal access approach, 41 (64%) cases were completed with 17 performed open from the onset. Open surgery was indicated in neonates who became symptomatic within the first few weeks of life as well as patients in respiratory distress that would not tolerate either single-lung ventilation or gas insufflation. There were six further conversions to open from minimal access surgery due to poor visualization or technical dif...

Source: European Journal of Pediatric Surgery - October 9, 2016 Category: Surgery Authors: Thakkar, Hemanshoo Sudhir Durell, Jonathan Chakraborty, Subhasis Tingle, Bianca-Lea Choi, Arnwald Fowler, Darren J. Gould, Steve J. Impey, Lawrence Lakhoo, Kokila Tags: Original Article Source Type: research