Scientific Letter
Short-term Outcome of Percutaneous Treatment of Pulmonary Sequestration in a Pediatric Hospital in the Andes: A Case Series
Resultados a corto plazo del tratamiento percutáneo de secuestro pulmonar en hospital pediátrico ubicado en la región andina: serie de casos
a Servicio de Cardiología y Hemodinamia, Hospital Pediátrico Baca Ortiz, Ministerio de Salud Pública, Quito, Ecuador
b Servicio de Imagenología, Hospital Pediátrico Baca Ortiz, Ministerio de Salud Pública, Quito, Ecuador
c Servicio de Neumología, Hospital Pediátrico Baca Ortiz, Ministerio de Salud Pública, Quito, Ecuador
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Ríos-Méndez, Jimena N. Andrade-Herrera, María E. Aráuz-Martínez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Raúl E." "apellidos" => "Ríos-Méndez" "email" => array:1 [ 0 => "riosmendez@intramed.net.ar" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Jimena N." "apellidos" => "Andrade-Herrera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "María E." "apellidos" => "Aráuz-Martínez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Cardiología y Hemodinamia, Hospital Pediátrico Baca Ortiz, Ministerio de Salud Pública, Quito, Ecuador" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Imagenología, Hospital Pediátrico Baca Ortiz, Ministerio de Salud Pública, Quito, Ecuador" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Pediátrico Baca Ortiz, Ministerio de Salud Pública, Quito, Ecuador" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Resultados a corto plazo del tratamiento percutáneo de secuestro pulmonar en hospital pediátrico ubicado en la región andina: serie de casos" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Pryce<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> described pulmonary sequestration (PS) as a spectrum of abnormalities in which part of the lung, with or without bronchial communication, receives aberrant systemic arterial vascularization. The extralobar type is covered by the pleura itself and drains into the systemic veins, while the intralobar type shares the pleura with the rest of the lung and drains into the pulmonary veins; it accounts for 0.15%–6.4% of all congenital pulmonary malformations. Treatment has conventionally been surgical, although nowadays a less invasive option is available in the form of percutaneous treatment.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2–4</span></a> Very few series of children with PS treated with embolization have been published, so we would like to report our experience in the percutaneous treatment of PS in a pediatric hospital in the Ecuadorian Andes.</p><p id="par0010" class="elsevierStylePara elsevierViewall">This was a cross-sectional study with consecutive sampling performed between March 2014 and April 2016. Data in common (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>): single artery feeding PS; vascular access via the femoral artery. No complications occurred, except in the first patient. Check-up with tomography was performed in patients 1, 2, and 3. Informed consent was obtained for all patients.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">In the first case, PS was suspected on radiograph, so we requested a tomography that confirmed a large PS. The procedure was complicated by reduced femoral pulse, treated with enoxaparin; the patient then developed systemic inflammatory response syndrome (SIRS) requiring intensive care. During follow-up, femoral pulses remained symmetric, pulmonary scintigraphy was normal, and the tomography showed full resolution of the PS.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In the other cases, PS was detected during catheterization. The second patient was catheterized due to suspected pulmonary hypertension on echocardiography. The third patient underwent catheterization due to poor progress after intervention for tetralogy of Fallot. Dilated bronchial arteries were detected and occluded with a 6<span class="elsevierStyleHsp" style=""></span>mm Amplatzer™ vascular plug (AVP)-II, and an AVP-I was implanted in the vessel feeding the PS. Residual flow was observed, so a Gianturco coil (GC) was implanted, completing occlusion of the aberrant artery. The fourth patient underwent catheterization after developing cyanosis. The last patient had a diagnosis of tetralogy of Fallot and collateral vessels on echocardiography, so catheterization was indicated, during which the diagnosis was ruled out.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The essential component for diagnosing PS is angio-MRI, angio-tomography, or systemic artery angiogram of abnormal feeding of the pulmonary region. It is not yet clearly defined whether PS should be treated percutaneously or surgically, and the situation is even less clear if the patient is asymptomatic.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Surgical treatment might require lobectomy, cause bleeding, infection or pneumothorax, and hospital stay is extended. Percutaneous treatment involves less risk of bleeding, is less incapacitating, and reduces length of hospital stay. However, complications, such as vascular events and SIRS, may occur, particularly in small children with large PS.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Several types of devices have been used for PS embolization<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2,4</span></a>: we use AVP and GC because of their availability, safety and proven effectiveness in vascular occlusion, and their accessible, state-funded cost.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Patients were followed up with tomography 6 months after the procedure, and in all cases it was confirmed that the aberrant vessel had not rechanneled, the PS had resolved, and the residual lung had expanded. Resolution and expansion were particularly evident in the first patient, who had presented a very large PS; in this patient, the pulmonary scintigraphy also showed normal uptake in the right lung.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Although no significant differences have been identified between surgery and percutaneous intervention in terms of mortality, series with large numbers of patients undergoing surgery report 7–14 days of hospitalization, chest tube for 4 days, and lobectomy in most cases, particularly if the PS was intralobar.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3,5</span></a> We did not make a comparative study of the 2 techniques, but these comorbidities are avoided with the use of percutaneous treatment.</p><p id="par0050" class="elsevierStylePara elsevierViewall">To our knowledge, this is the second report of percutaneous treatment for PS in children in South America,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> and while endovascular was safe and effective in our series, it is still early to recommend it as an initial treatment choice, because more experience is required. However, thanks to the growing body of information about its effectiveness,<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2–4</span></a> it can be considered as a first treatment option in places where resources are limited in terms of intensive care beds or the availability of pediatric surgeons trained in the correction of congenital pulmonary disorders.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ríos-Méndez RE, Andrade-Herrera JN, Aráuz-Martínez ME. Resultados a corto plazo del tratamiento percutáneo de secuestro pulmonar en hospital pediátrico ubicado en la región andina: serie de casos. Arch Bronconeumol. 2017;53:163–164.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">AVP (I and II): Amplatzer™ vascular plug (I and II); CAVC: complete atrioventricular canal; GC: Gianturco coils; LIB: left intralobar base; m: months; REB: right extralobar base; RF: residual flow; RIB: right intralobar base; PAT: pulmonary artery trunk; PS: pulmonary sequestration.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Case \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Age \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">PS Type \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Arterial Diameter \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Device \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Aortic Origin of Feeding Artery \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">RF \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Hospitalization \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Associated Diseases \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Follow-up (Months) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.5<span class="elsevierStyleHsp" style=""></span>m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">REB \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.5<span class="elsevierStyleHsp" style=""></span>mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">AVP-II 3<span class="elsevierStyleHsp" style=""></span>mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Descending thoracic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RIB \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3<span class="elsevierStyleHsp" style=""></span>mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">AVP-II 6<span class="elsevierStyleHsp" style=""></span>mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Abdominal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 day \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Scimitar syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8<span class="elsevierStyleHsp" style=""></span>m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RIB \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5<span class="elsevierStyleHsp" style=""></span>mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">AVP-I 8<span class="elsevierStyleHsp" style=""></span>mm+GC 3<span class="elsevierStyleHsp" style=""></span>mm×4<span class="elsevierStyleHsp" style=""></span>mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Abdominal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">After intervention for tetralogy of Fallot \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">LIB \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.8<span class="elsevierStyleHsp" style=""></span>mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">GC 3<span class="elsevierStyleHsp" style=""></span>mm×4<span class="elsevierStyleHsp" style=""></span>mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Abdominal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 day \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Trisomy 21+unbalanced CAVC+PAT banding \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RIB \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2<span class="elsevierStyleHsp" style=""></span>mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">AVP-II 3<span class="elsevierStyleHsp" style=""></span>mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Abdominal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 day \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tetralogy of Fallot \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1377617.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Common Data in Patients With Pulmonary Sequestration.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lower accessory pulmonary artery with intralobar sequestration of lung; 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 2 | 1 | 3 |
| 2024 October | 47 | 17 | 64 |
| 2024 September | 48 | 14 | 62 |
| 2024 August | 79 | 29 | 108 |
| 2024 July | 39 | 19 | 58 |
| 2024 June | 56 | 34 | 90 |
| 2024 May | 91 | 28 | 119 |
| 2024 April | 46 | 34 | 80 |
| 2024 March | 35 | 21 | 56 |
| 2024 February | 30 | 17 | 47 |
| 2023 March | 5 | 3 | 8 |
| 2023 February | 32 | 16 | 48 |
| 2023 January | 23 | 24 | 47 |
| 2022 December | 38 | 25 | 63 |
| 2022 November | 37 | 19 | 56 |
| 2022 October | 43 | 29 | 72 |
| 2022 September | 31 | 31 | 62 |
| 2022 August | 36 | 44 | 80 |
| 2022 July | 28 | 36 | 64 |
| 2022 June | 24 | 29 | 53 |
| 2022 May | 38 | 42 | 80 |
| 2022 April | 25 | 32 | 57 |
| 2022 March | 43 | 36 | 79 |
| 2022 February | 38 | 25 | 63 |
| 2022 January | 34 | 44 | 78 |
| 2021 December | 25 | 36 | 61 |
| 2021 November | 34 | 46 | 80 |
| 2021 October | 29 | 51 | 80 |
| 2021 September | 30 | 44 | 74 |
| 2021 August | 26 | 31 | 57 |
| 2021 July | 22 | 25 | 47 |
| 2021 June | 36 | 30 | 66 |
| 2021 May | 31 | 29 | 60 |
| 2021 April | 79 | 83 | 162 |
| 2021 March | 44 | 20 | 64 |
| 2021 February | 21 | 22 | 43 |
| 2021 January | 31 | 10 | 41 |
| 2020 December | 20 | 13 | 33 |
| 2020 November | 22 | 11 | 33 |
| 2020 October | 29 | 15 | 44 |
| 2020 September | 16 | 15 | 31 |
| 2020 August | 17 | 15 | 32 |
| 2020 July | 41 | 22 | 63 |
| 2020 June | 9 | 5 | 14 |
| 2020 May | 33 | 6 | 39 |
| 2020 April | 61 | 16 | 77 |
| 2020 March | 34 | 14 | 48 |
| 2020 February | 78 | 17 | 95 |
| 2020 January | 63 | 20 | 83 |
| 2019 December | 25 | 18 | 43 |
| 2019 November | 38 | 18 | 56 |
| 2019 October | 30 | 10 | 40 |
| 2019 September | 21 | 11 | 32 |
| 2019 August | 10 | 8 | 18 |
| 2019 July | 25 | 18 | 43 |
| 2019 June | 10 | 9 | 19 |
| 2019 May | 27 | 16 | 43 |
| 2019 April | 40 | 12 | 52 |
| 2019 March | 25 | 15 | 40 |
| 2019 February | 19 | 13 | 32 |
| 2019 January | 8 | 12 | 20 |
| 2018 December | 49 | 12 | 61 |
| 2018 November | 61 | 21 | 82 |
| 2018 October | 68 | 21 | 89 |
| 2018 September | 44 | 7 | 51 |
| 2018 May | 13 | 2 | 15 |
| 2018 April | 15 | 10 | 25 |
| 2018 March | 14 | 3 | 17 |
| 2018 February | 26 | 8 | 34 |
| 2018 January | 19 | 5 | 24 |
| 2017 December | 20 | 4 | 24 |
| 2017 November | 19 | 4 | 23 |
| 2017 October | 26 | 7 | 33 |
| 2017 September | 19 | 10 | 29 |
| 2017 August | 21 | 15 | 36 |
| 2017 July | 19 | 9 | 28 |
| 2017 June | 37 | 18 | 55 |
| 2017 May | 3 | 0 | 3 |
| 2017 April | 2 | 0 | 2 |
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