Congenital Lung Malformations: Pulmonary Function Assessment Before and After Surgery

Background: The management of asymptomatic congenital lung malformations (CLM) is debated, and pulmonary function of patients with CLM is seldom discussed. Short-term respiratory outcome in patients operated for CLM was assessed in order to better define surgical impact. Methods: A retrospective study on patients operated for CLM between 2012 and 2021 was performed. Respiratory function was assessed with tidal breath analysis (TBA) in spontaneous sleep within 2 years of life. Patients with comorbidities affecting pulmonary function were excluded. Three variables were studied: tPTEF/tE (time to peak tidal expiratory flow/total expiratory time), tV (tidal volume), RR (respiratory rate). Results were assessed as z-score (normal ±1.64) and expressed as median (range). Pre- and post-operative results were compared, as well as post-operative results of disease and surgery type subgroups. Results: Thirty-nine patients were included. Median pre- and post-operative tPTEF/tE were normal (pre: −0.32 (−2.12; +1.56); post: −0.18 (−1.62; +2.43)). Patients with extralobar sequestration had pre-operative high median RR, which improved after sequestrectomy (pre: +1.99 (−2.49; +7.43); post −0.22 (−3.01; +1.18)). All groups had reduced pre-operative median tV, which restored after surgery (pre: −2.15 (−9.75; +0.91); post: −0.35 (−6.65; +3.14)). Patients undergoing lobectomy and patients with intralobar sequestration showed greater improvement. Median post-operative TBA results were normal for all sub-groups except for reduced tV in patients operated with thoracotomy (−2.27 (−6.12; +5.26)). Conclusions: Patients with clinically asymptomatic CLM can have pathologic pulmonary function tests, which improve after surgery. These results add to the elements in favor of an interventional approach. Level of evidence: III, Treatment study.