Malformations of the lungs: analysis of the postoperative deaths and conclusions for improvement in therapy

Complications of pulmonary surgery in childhood which should be prevented are: 1. Wrong indication for thoracotomy. An exact preoperative diagnosis including angiography is necessary to diagnose exactly the morphological abnormalities (i.e. arteriovenous fistulae). 2. Technical mistakes: Identifying vascular connections in cases of sequestrations of the lung which may transverse the diaphragm; priority of ligation of the vessels in pulmonary resections carried out for arterio-venous fistulae, i.e. the artery must be ligated first then the vein. If haemorrhage will occur from the vena cava, longitudinal clamps must be applied. Blindly carried out punctures of the lung are contraindicated. Pleural drainage catheters should be placed one intercostal space higher than the hole where they pass through the skin. In cases with cysts of the lung (i.e. echinococcus) where there is a danger of a rupture of the cyst into a bronchus, unilateral intubation is indicated.