Postpneumonectomy syndrome in children: Advantages and long-term follow-upof expandable prosthesis

Background/Purpose: Pneumonectomy in children can be complicated by a sever e mediastinal shift, which leads to bronchial stretching resulting in sever e 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 pne umonectomy. Seven of these patients were treated surgically for severe mani festations of postpneumonectomy syndrome. First insertion of an expandable prosthesis was followed up in 6 cases by its remplacement with a breast pro sthesis 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 implanta tion was 5 years (range, 11 months to 8 years). Pulmonary function tests sh owed a substantial improvement in the obstructive syndrome in all patients except one, in whom the functional improvement was moderate. The mean follo w-up after the expandable prosthesis implantation was 6 years (range, 6 mon ths 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 syndrom e. The expandable prosthesis allowed for progressive, well-tolerated recent ering of the mediastinum and adjustement for growth. J Pediatr Surg 36:1425 -1427. Copyright (C) 2001 by W.B, Saunders Company.