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Eur J Cardiothorac Surg 2002;22:587-594
© 2002 Elsevier Science NL
a Department of Cardiothoracic Surgery, Wentworth and King George V Hospitals, Nelson R. Mandela School of Medicine, University of Natal, Durban, South Africa
b Department of Anaesthetics, Wentworth Hospital, Nelson R. Mandela School of Medicine, University of Natal, Durban, South Africa
Received 3 January 2002; received in revised form 21 June 2002; accepted 26 June 2002.
* Corresponding author. Tel.: +27-31-4605112/3; fax: +27-31-4611724
e-mail: blyth{at}nu.ac.za
Objectives: Surgical literature carries relatively scant information on pneumonectomy in children. We reviewed our experience over 7 years, determined the risk/benefit ratio and compared our experience with reports from the literature. Methods: The records of children undergoing pneumonectomy, 14 years and younger, over a 7-year period from January 1991 to December 1997, are analysed, the techniques used to determine the need for and extent of surgery are studied, whilst the problems and outcome of surgery in this age group are determined. Results: Fifty-nine children, 40 males, 19 females, aged 6 months to 14 years, average age of 7.5 years, underwent pneumonectomy. A history of pulmonary infection/s and a chest radiograph suggestive of lung destruction were indicators for investigation by bronchography and/or computerized axial tomography of the chest (HRCT scan). This determined the nature and extent of disease and the possibility and extent of surgery required. Bronchus blockers (22), five others in combination with the prone operating position, prone position (six) and a double lumen tube in one, were used to protect the healthy lung at surgery. Spill of pus was recognized once with a bronchus blocker and the prone position used in combination. Six intra-operative complications (10.1%) were recognized: bronchial spill (one) without consequence, conversion of bi-lobectomy to pneumonectomy due to pulmonary artery injury (one), cardiac arrest (with resuscitation, one), bradycardia with hypotension (one), excessive bleeding (one) and intra-pleural spill of debris (one), the last without consequence. Seven post-operative complications (11.8%) occurred: one empyema (sterilized), bleeding one, pulmonary infection two, suspected but unproven broncho-pleural fistulae two, prolonged antibiotics in one, reason unrecorded. One pneumonectomy through an empyema was uncomplicated. The main histological features were bronchiectasis (38), active tuberculosis (eight), end-stage lung (five), collapse and pulmonary haemorrhage (one), lobar emphysema (one). Histology unrecorded (one). No death occurred. All patients left hospital well. Conclusions: Careful preparation, often including anti-tuberculosis cover, and timing of pneumonectomy are essential. Meticulous anaesthetic and surgical technique and co-operation are critical. Bronchus blockers functioned well but are not without risk. Attention to detail makes pneumonectomy safe in childhood.
Key Words: Pneumonectomy • Children • Inflammatory lung disease
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  S. Eren, M. N. Eren, and A. E. Balci Pneumonectomy in children for destroyed lung and the long-term consequences J. Thorac. Cardiovasc. Surg., August 1, 2003; 126(2): 574 - 581. [Abstract] [Full Text] [PDF]
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