Millendez Maridelle B, Ridout Erick, Pole Ginger, Edwards Mary
Uniformed Services University of the Health Sciences, F. Edward Hebert School of Medicine, Bethesda, MD, USA.
J Pediatr Surg. 2007 Jul;42(7):1276-8. doi: 10.1016/j.jpedsurg.2007.02.021.
Intralobar pulmonary sequestrations are congenital lung malformations sometimes known to cause symptoms of heart failure in the neonate because of shunting of blood flow from an anomalous systemic feeding artery into the pulmonary venous system. These are cured by pulmonary lobectomy. We report the case of a 37-weeks' gestational age infant who presented with bilateral pleural effusions perinatally, followed by hypertensive heart failure and hyperreninemia 2 weeks postnatally. Computed tomography revealed a large artery from the infradiaphragmatic aorta proximal to the celiac axis supplying a right lower lobe intralobar pulmonary sequestration and 4 small nonstenosed renal arteries. Subsequent to a right lower lobectomy, the patient recovered with a precipitous drop in plasma renin assay level and was discharged from the neonatal intensive care unit in good condition 12 days postoperatively. This is the first reported case of hyperreninemia treated by lobectomy. We hypothesize that the aberrant feeding vessel resulted in a relative deficiency in renal perfusion via a "steal" effect that was relieved by surgical ligation of the artery.
叶内型肺隔离症是一种先天性肺发育畸形，有时因异常的体循环供血动脉的血流分流至肺静脉系统，导致新生儿出现心力衰竭症状。这些通过肺叶切除术治愈。我们报告一例孕37周的婴儿，其出生时即出现双侧胸腔积液，出生后2周出现高血压性心力衰竭和高肾素血症。计算机断层扫描显示，在腹腔干轴近端的膈下主动脉发出一条大动脉，为右肺下叶叶内型肺隔离症供血，还有4条细小无狭窄的肾动脉。右下肺叶切除术后，患者血浆肾素测定水平急剧下降，术后12天从新生儿重症监护病房顺利出院。这是首例报道的通过肺叶切除术治疗高肾素血症的病例。我们推测，异常供血血管通过“窃血”效应导致肾灌注相对不足，而动脉的手术结扎缓解了这种效应。
