Pediatric Thoracic Surgery

This book discusses all thoracic diseases of surgical interest, from thorax malformations to airways disorders. It is divided into six main sections; the first two analyze general aspects, while the following three focus on malformations of the thorax, airways, esophagus and diaphragm. The final section describes the main pediatric tumors involving the chest and internal thoracic organs. Each chapter starts with a classification of the main pathologies related to the anatomical region considered. For each pathology, the various aspects of the diagnostic-therapeutic procedure are described in details - from the clinical presentation and diagnosis to the pre-operative preparation, the surgical aspects, and the post-operative course. Possible future developments are also evaluated. The volume will be a useful tool for specialists in pediatric and thoracic surgery, but will also represent an educational resource for medical and nursing students. Preface Contents Part I: Introductory Aspects 1: Thoracic Surgery in Pediatric Patients References 2: Management Aspects: Quality, Ethics, and Economic Sustainability 2.1 Ethical Aspects 2.2 Economical Aspects 2.3 Why Are Quality Standards So Important? 2.4 What Must Those Who Are Responsible for Maintaining These Quality Standards Evaluate and What Action Must be Taken to Guarantee Services Up to the Required Standards? Reference Part II: General Aspects 3: Prenatal Diagnosis and Perinatal Management of Thoracic Anomalies 3.1 Normal Sonographic Anatomy of the Thorax 3.2 Congenital Diaphragmatic Hernia (CDH) 3.3 Congenital Cystic Adenomatoid Malformation of the Lung (C-CAML) 3.4 Pulmonary Sequestration (PS) 3.5 Bronchial Atresia 3.6 Laryngeal Atresia 3.7 Bronchogenic Cyst 3.8 Lung Agenesis/Hypoplasia 3.9 Hydrothorax 3.10 Mediastinal Tumors/Cysts 3.11 Esophageal Atresia (EA) and Tracheoesophageal (TE) Fistula References 4: Imaging of the Chest 4.1 Introduction 4.2 Radiography 4.3 Ultrasound 4.4 Computed Tomography 4.5 Magnetic Resonance Imaging References 5: Anesthesia in Thoracic Surgery 5.1 Introduction 5.2 Preoperative Evaluation 5.3 Intraoperative Management 5.4 Single Lung Ventilation (SLV) During Pediatric Thoracic Surgery 5.4.1 Ventilation and Perfusion During Thoracic Surgery: Adults versus Children 5.4.2 Indications and Techniques for SLV in Infants and Children 5.4.3 ABCDs of Pediatric Lung Isolation 5.4.4 Options for Lung Isolation 5.4.4.1 Single-Lumen Endotracheal Tube 5.4.4.2 Univent Tube 5.4.4.3 Bronchial Blockers 5.4.4.4 Double-Lumen Tubes (DLTs) 5.4.5 Strategies for Treating and Avoiding Hypoxemia During Single Lung Ventilation 5.4.6 Conclusion 5.5 Anesthesiologic Management of the Main Surgical Pathologies in Pediatric Population 5.5.1 Congenital Lung Lesions 5.5.1.1 Anesthesia Consideration and Management of Congenital Lung Malformations 5.5.2 Congenital Diaphragmatic Hernia 5.5.2.1 Anesthesia Consideration and Management of Neonates with CDH 5.5.3 Tracheoesophageal Fistula and Esophageal Atresia 5.5.3.1 Preoperative Airway Management of TEF/AE 5.5.3.2 Anesthesia Consideration and Management of Infants with TEF/AE 5.5.4 Mediastinal Masses 5.5.4.1 Anesthesia Consideration and Management of Children With Mediastinal Mass 5.5.5 Pectus Excavatum Or Carinatum 5.5.5.1 Anesthesia Consideration and Management of Patients with Pectus Excavatum/Carinatum 5.6 Management of Postoperative Pain References 6: Extracorporeal Membrane Oxygenation 6.1 Introduction 6.2 Hardware 6.2.1 ECMO Pumps 6.3 Oxygenator 6.4 ECMO Configuration 6.4.1 Veno-Venous ECMO 6.4.2 Veno-Arterial ECMO 6.4.3 Determinants of Flow 6.4.4 ECMO Physiology: Oxygen Consumption and Delivery 6.5 Starting an ECMO Run: Practical Aspects 6.5.1 Cannulas and Flows 6.5.2 Oxygenator 6.5.2.1 Priming 6.5.2.2 Monitoring 6.5.2.3 Flow 6.5.2.4 Negative Aspiration Pressures 6.5.2.5 Positive Pressures 6.5.2.6 Recirculation 6.5.2.7 Cannulation Technique 6.5.2.8 Anticoagulation 6.6 ECMO for Airway and Tracheal Surgery References 7: Pulmonary Function Tests 7.1 Spirometry 7.2 Indications and Contraindications to Spirometry 7.2.1 Performing the Spirometry Test 7.2.2 FVC Test Maneuver 7.2.3 Rating the Spirometry Results 7.2.4 Bronchodilator Response 7.2.5 Methacholine Challenge Test (MCT) 7.3 Conclusions References Part III: Chest Wall 8: Pectus Excavatum 8.1 Introduction 8.2 Classification 8.3 Diagnosis 8.4 Treatment 8.5 Conclusion References 9: Pectus Carinatum 9.1 Introduction 9.2 Classification 9.3 Diagnosis 9.4 Treatment 9.5 Conclusions References 10: Poland Syndrome 10.1 Introduction 10.2 Classification 10.3 Diagnosis 10.4 Treatment References 11: Jeune Syndrome 11.1 Introduction and Classification 11.2 Diagnosis 11.3 Treatment References Part IV: Airways 12: Anomalies of the Larynx 12.1 Introduction 12.2 Classification 12.3 Clinical Presentation, Diagnosis, and Treatment References 13: Anomalies of the Trachea 13.1 Tracheal Agenesis 13.1.1 Classification 13.1.2 Diagnosis 13.1.3 Treatment 13.1.4 Conclusion 13.2 Laryngotracheoesophageal Cleft 13.2.1 Classification 13.2.2 Diagnosis 13.2.3 Treatment 13.2.3.1 Endoscopic Repair 13.2.3.2 Surgical Open Repair (Fig. 13.2) 13.2.4 Conclusions 13.3 Tracheomalacia 13.3.1 Classification 13.3.2 Diagnosis 13.3.3 Treatment 13.3.3.1 Aortopexy 13.3.3.2 Tracheopexy 13.3.3.3 Internal Stent 13.3.3.4 External Splint 13.3.4 Conclusions 13.4 Congenital Tracheal Stenosis 13.4.1 Classification 13.4.2 Diagnosis 13.4.3 Treatment 13.4.3.1 Resection with End-to-End Anastomosis 13.4.3.2 Anterior Patch Tracheoplasty 13.4.3.3 Tracheal Autograft 13.4.3.4 Slide Tracheoplasty 13.4.3.5 Tracheoplasty with Cadaveric Tracheal Homografts 13.4.4 Conclusions 13.5 Traumatic Acquired Lesions 13.5.1 Diagnosis 13.5.2 Treatment 13.5.3 Tracheal Lesions References 14: Tracheostomy 14.1 Introduction 14.2 Indications 14.3 Procedure 14.4 Complications 14.5 Final Comments References 15: Cystic Mediastinal Masses in Children 15.1 Introduction 15.2 Thymic Cyst 15.3 Bronchogenic Cyst 15.4 Esophageal Duplication Cyst 15.5 Lymphangioma 15.6 Pericardial Cysts 15.7 Neurenteric Cyst References 16: Congenital Lung Malformations 16.1 Introduction 16.2 Bronchial Atresia 16.2.1 Diagnosis 16.2.2 Management 16.3 Bronchogenic Cyst 16.3.1 Diagnosis 16.3.2 Management 16.4 Congenital Pulmonary Airway Malformation (CPAM) 16.4.1 Diagnosis 16.4.2 Management 16.5 Congenital Lobar Emphysema 16.5.1 Diagnosis 16.5.2 Management 16.6 Pulmonary Sequestration (And Hybrid Lesion) 16.6.1 Diagnosis 16.6.2 Management 16.7 Surgical Management of CLM References Part V: Oesphagus and Diaphragm 17: Esophageal Atresia 17.1 Introduction 17.2 Embryology and Classification 17.3 Diagnosis 17.3.1 Postnatal Signs 17.3.2 Definition of Surgical Timing 17.4 Treatment 17.4.1 Thoracoscopic Approach 17.4.2 Thoracotomic Approach 17.4.3 Postoperative Management 17.5 Complications 17.6 Esophageal Duplication 17.6.1 Introduction 17.7 Classification 17.8 Diagnosis 17.9 Treatment 17.10 Conclusion References 18: Congenital Diaphragmatic Hernia 18.1 Introduction 18.2 Classification 18.3 Diagnosis 18.4 Treatment 18.4.1 Definition of Surgical Timing 18.4.2 Surgical Treatment 18.5 Conclusion References 19: Diaphragmatic Eventration 19.1 Introduction 19.2 Classification 19.3 Diagnosis 19.4 Treatment 19.5 Conclusion References 20: Sternal Clefts and Cantrell Syndrome 20.1 Introduction 20.2 Classification 20.3 Diagnosis 20.4 Treatment 20.5 Conclusion References Part VI: Oncology 21: Main Thoracic Tumors in Pediatric Age 21.1 Introduction 21.2 Classification 21.2.1 Mediastinal Tumors 21.2.1.1 Anterior Mediastinum Thymus Lymphoma Germ Cell Tumors 21.2.1.2 Middle Mediastinum 21.2.1.3 Posterior Mediastinum Neurogenic Tumors Nerve Sheath and Nerve Tumors Paragangliomas Nonneurogenic Posterior Mediastinal Masses 21.2.2 Lung Primary and Secondary Tumors 21.2.2.1 Pleuropulmonary Blastoma 21.2.2.2 Secondary Lung Tumors 21.2.2.3 Osteosarcoma 21.2.2.4 Wilms Tumor 21.2.2.5 Hepatoblastoma 21.2.2.6 Neuroblastoma 21.2.2.7 Rhabdomyosarcoma 21.2.2.8 Non-Rhabdomyosarcoma Soft Tissue Sarcoma (NRSTS) 21.2.2.9 Ewing Sarcoma 21.2.2.10 Adrenocortical Carcinoma 21.2.3 Bronchial Tumors 21.2.4 Chest Wall Tumors 21.3 Surgical Approaches in Pediatric Thoracic Tumors 21.3.1 Posterolateral Thoracotomy 21.3.2 Thoracoscopy 21.3.2.1 Surgeon and Patient 21.3.2.2 Anesthesia 21.3.2.3 Localization and Biopsy 21.3.2.4 Future Developments 21.3.3 Cervicothoracic Tumors 21.3.3.1 Transmanubrial Approach 21.3.3.2 Trap-door Incision 21.3.3.3 Sternotomy 21.3.4 Thoraco-abdominal Tumors 21.3.4.1 Thoraco-phrenolaparotomy 21.3.5 Bilateral Thoracic Tumors 21.3.5.1 Clamshell Incision 21.4 Complications 21.4.1 Cardiopulmonary Complications 21.4.1.1 Atelectasis 21.4.1.2 Pneumonia 21.4.1.3 Respiratory Distress Syndrome (RDS) 21.4.2 Complications of Chest Incision 21.4.3 Complications of Pulmonary and Bronchial Resection 21.4.3.1 Pneumothorax 21.4.3.2 Restrictive Pulmonary Function 21.4.4 Complications Involving the Pleural Space 21.4.4.1 Pleural Effusion 21.4.5 Complications of Mediastinal Surgery 21.4.5.1 Chylothorax 21.4.5.2 Diaphragmatic Paralysis 21.4.5.3 Spinal Ischemia 21.4.5.4 Horner Syndrome References