Congenital and acquired single-lung patients: long-term follow-up reveals high mortality risk.

PURPOSE: Single-lung patients are uncommon. Case reports suggest that these patients have significant morbidity and mortality risks because of associated anomalies, airway obstruction as well as decreased pulmonary reserve. This study was designed to review morbidity and mortality of single-lung patients.

METHODS

A retrospective review of single-lung patients admitted to our hospital from January 1988 to June 2007.

RESULTS

Twelve single-lung patients were treated in our hospital with mean follow-up of 22.9 months. Six congenital lung aplasia patients presented as neonates, with 2 diagnosed antenatally. Of 4 patients with respiratory distress, 3 required surgical interventions to correct airway symptoms. Three patients died before 9 months of age because of respiratory failure, sepsis, or cardiac arrest. The remaining survivors have minimal respiratory distress. There were 6 pneumonectomy patients as follows: 5 for malignancies and 1 for bronchiectasis. There were 2 deaths from recurrent disease. Four patients had respiratory symptoms with one patient requiring tissue expander insertion for the correction of airway torsion from mediastinal shift.

CONCLUSIONS

The morbidity and mortality of infant single-lung patients are significant. Respiratory distress from decreased pulmonary reserve must be distinguished from airway obstruction because of mediastinal shift. Bronchoscopic assessment was invaluable to the diagnosis and management of these patients.