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Document Details :

Title: Treatment strategies for pulmonary sequestration in childhood: resection, embolization, observation?
Author(s): S.C. Brown , M. De Laat , M. Proesmans , K. De Boeck , D. Van Raemdonck , J. Louw , R. Heying , B. Cools , B. Eyskens , M. Gewillig
Journal: Acta Cardiologica
Volume: 67    Issue: 6   Date: 2012   
Pages: 629-634
DOI: 10.2143/AC.67.6.2184664

Abstract :
Background: The ideal treatment strategy for pulmonary sequestration whether resection or embolization in childhood is not clearly defined. Our institution has no clear policy, therefore both therapies are performed.
Objective: The aim of this study was to assess local management strategies of children presenting with pulmonary sequestrations.
Methods: This is a retrospective, single-institutional review. The main inclusion criterion was the established diagnosis of a pulmonary sequestration. Forty-eight patients were divided into three groups based on treatment received: conservative management (n = 5), surgery (n = 22) and embolization (n = 21).
Results: The median age at treatment was 8.0 months (range 1.2 – 166.0) in the surgical, 4.0 months (range 0.2 – 166.0) in the embolization and 8 months (range 0.3 – 197.0) in the conservatively managed groups, respectively. Age at treatment was similar in the surgical and embolization groups (P = 0.9). Recurrent chest infections were the most common clinical presentation in the surgical group, whilst cardiac failure was the most frequent symptom in the embolization group (P < 0.01; 95% CI: 0.3 to 0.9). There were six complications in the surgical group and one in the embolization group (P = 0.1). In one patient embolization was not possible. Outcomes in both groups were comparable with good results on follow-up.
Conclusion: Both surgery and endovascular embolization are effective and safe treatments for pulmonary sequestration. The presenting symptoms dictate therapy: surgery if there is infection and embolization if a shunt needs to be abolished. Our institutional policy remains unchanged.