Successful perioperative management of congenital cystic adenomatoid malformation of the lung by high frequency oscillatory ventilation--report of two cases.

BACKGROUND

Comparable to congenital diaphragmatic hernia, patients with congenital cystic adenomatoid malformation of the lung (CCAM) may develop life-threatening mediastinal shift and persistent pulmonary hypertension. In patients with diaphragmatic hernia, high frequency oscillatory ventilation (HFOV) has been shown to allow perioperative stabilisation.

PATIENTS: One term and one premature newborn of 30 gestational weeks with CCAM. Both patients developed massive mediastinal shift and intermittend pulmonary hypertension.

METHOD: Retrospective chart review.

RESULTS

In both patients perioperative stabilisation could be achieved by institution of HFOV. This allowed safe operation in the almost immobile surgical site and controlled transient episodes of pulmonary hypertension. The resection of the malformed lobe was performed under continued HFOV on the neonatal intensive care unit. Hereby, transport stress and additional hyperinflation by hand ventilation could be avoided.

CONCLUSION

Comparable with the situation when repairing a congenital diaphragmatic hernia, perioperative HFOV may be advantageous in managing severe CCAM.