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. 2023 Dec 18:11:1301902.
doi: 10.3389/fped.2023.1301902. eCollection 2023.

Aggressive approach for spontaneous pneumothorax treatment in children with Marfan syndrome?

Angelo Zarfati  1 , Simone Frediani  1 , Valerio Pardi  1 , Ivan Pietro Aloi  1 , Silvia Madafferi  1 , Antonella Accinni  1 , Arianna Bertocchini  1 , Alessandro Inserra  1
Affiliations

Aggressive approach for spontaneous pneumothorax treatment in children with Marfan syndrome?

Angelo Zarfati et al. Front Pediatr. .

Abstract

Background and objectives: Marfan syndrome (MS) is a systemic disease of connective tissues consisting of a variable combination of anomalies. These patients have an increased risk of spontaneous pneumothorax (SP). However, there is a scarcity of pediatric literature on management, and no specific guidelines exist. Our aim was to analyze the management of spontaneous pneumothorax in children and adolescents with Marfan syndrome, comparing syndromic and non-syndromic patients.

Methods: Retrospective analysis of pediatric patients (18 years) with SP diagnosed at our tertiary pediatric hospital (January 10-June 22), with special emphasis on diagnosis, treatment, and follow-up (FU).

Results: Sixty-six patients with SP were identified, with nine (13%) having MS. In terms of baseline, there were no significant differences between the groups (age, sex, asthma, symptoms, and side, first-line treatment and hospitalization length). Overall, Marfan patients had significantly more first-line treatment failures requiring additional surgery, as well as more contralateral occurrences and the need for surgery/chest drain during the follow-up. Instead, conservative management resulted in significantly more ipsilateral recurrences and the need for surgery/chest drain in Marfan patients than controls during the follow-up.

Conclusions: Treatment failure, contralateral occurrence, ipsilateral recurrence, and the need for surgery/chest drain during follow-up make management of patients with Marfan syndrome and spontaneous pneumothorax more difficult. In patients with a diagnosed MS a more aggressive first-line management should be considered, bearing in mind the higher risks of this population.

Keywords: Marfan syndrome; children; pneumothorax; thoracic drainage; thorax.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision. The reviewer GC declared a past co-authorship with the author AI to the handling editor.

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