Annals of surgery · 2024
Increased Musculoskeletal Deformities and Decreased Lung Volume in Patients After EA/Tef Repair: A Real-time MRI Study.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Aubert Ophelia, Lacher Martin, Mayer Steffi, Frahm Jens, Voit Dirk, Rosolowski Maciej, Widenmann Anke, Hirsch Franz W, Gräfe Daniel
Аннотация
OBJECTIVE: This study aims to assess morphologic and functional postoperative changes after open or minimally invasive (MIS) repair of esophageal atresia (EA) compared with healthy controls by thoracic real-time magnetic resonance imaging (MRI).
BACKGROUND: Musculoskeletal deformities and pulmonary morbidity are common in children after EA repair. The real-time MRI is a novel technique that provides ultrafast, high-quality images during spontaneous breathing, without sedation, even in young children.
METHODS: Children aged 3 to 18 years were prospectively examined with a 3 Tesla MRI. Musculoskeletal deformities, static thoracic cross-sectional areas (CSAs) at 3 different levels and lung volumes, as well as dynamic right-to-left ratio of CSA of hemithoraces and lung volumes during forced breathing were evaluated.
RESULTS: Seventy-two children (42 open, 8 MIS, 22 controls) were recruited. In the EA group, rib fusions and adhesions (78%, P <0.01) and scoliosis (15%, P =0.32) were found after thoracotomy but not after MIS. The mean right-to-left ratio of CSA and lung volumes were lower after EA repair compared with controls ( P <0.05), indicating impaired thoracic and lung development. The number of thoracotomies was a significant risk factor for smaller thoracic volumes ( P <0.05).
CONCLUSIONS: For the first time, morphologic changes and thoracic motility after EA repair were visualized by dynamic real-time MRI. After EA repair, children show decreased right-sided thoracic and lung development compared with controls. Open repair leads to significantly more musculoskeletal deformities. This study emphasizes that musculoskeletal morbidity following a thoracotomy in infancy is high.
BACKGROUND: Musculoskeletal deformities and pulmonary morbidity are common in children after EA repair. The real-time MRI is a novel technique that provides ultrafast, high-quality images during spontaneous breathing, without sedation, even in young children.
METHODS: Children aged 3 to 18 years were prospectively examined with a 3 Tesla MRI. Musculoskeletal deformities, static thoracic cross-sectional areas (CSAs) at 3 different levels and lung volumes, as well as dynamic right-to-left ratio of CSA of hemithoraces and lung volumes during forced breathing were evaluated.
RESULTS: Seventy-two children (42 open, 8 MIS, 22 controls) were recruited. In the EA group, rib fusions and adhesions (78%, P <0.01) and scoliosis (15%, P =0.32) were found after thoracotomy but not after MIS. The mean right-to-left ratio of CSA and lung volumes were lower after EA repair compared with controls ( P <0.05), indicating impaired thoracic and lung development. The number of thoracotomies was a significant risk factor for smaller thoracic volumes ( P <0.05).
CONCLUSIONS: For the first time, morphologic changes and thoracic motility after EA repair were visualized by dynamic real-time MRI. After EA repair, children show decreased right-sided thoracic and lung development compared with controls. Open repair leads to significantly more musculoskeletal deformities. This study emphasizes that musculoskeletal morbidity following a thoracotomy in infancy is high.