Postpneumonectomy syndrome in children: advantages and long-term follow-up of expandable prosthesis.
OBJECTIVE
Pneumonectomy in children can be complicated by a severe mediastinal shift, which leads to bronchial stretching resulting in severe respiratory failure. This postpneumonectomy syndrome can be corrected by inserting a prosthesis in the empty side of the chest.


METHODS
Forty-two children, from 6 months to 15 years old, underwent a pneumonectomy. Seven of these patients were treated surgically for severe manifestations of postpneumonectomy syndrome. First insertion of an expandable prosthesis was followed up in 5 cases by its replacement with a breast prosthesis in adolescence. The expandable prosthesis was injected periodically with saline solution to maintain the mediastinum in a midline position as the children grew.


RESULTS
The mean delay between pneumonectomy and first prosthesis implantation was 5 years (range, 11 months to 8 years). Pulmonary function tests showed a substantial improvement in the obstructive syndrome in all patients except one, in whom the functional improvement was moderate. The mean follow-up after the expandable prosthesis implantation was 6 years (range, 6 months to 10 years) and all patients are doing well.


CONCLUSIONS
The insertion of an intrathoracic prosthesis can dramatically improve the clinical symptoms and reduce the functional obstructive syndrome. The expandable prosthesis allowed for progressive, well-tolerated recentering of the mediastinum and adjustment for growth.
Podevin
G
G
CHU Hotel Dieu, Nantes, and the Hôpital A. Trousseau, Paris, France.
Larroquet
M
M
Camby
C
C
Audry
G
G
Plattner
V
V
Heloury
Y
Y
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D011013:Pneumonectomy / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000601:surgery; D019736:Prostheses and Implants; D011474:Prosthesis Design; D012129:Respiratory Function Tests; D012131:Respiratory Insufficiency / Q000209:etiology / Q000601:surgery*; D018570:Risk Assessment; D013577:Syndrome; D013997:Time Factors; D016896:Treatment Outcome