{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T13:18:36Z","timestamp":1785763116159,"version":"3.56.0"},"reference-count":13,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background and Objectives: Pulmonary sequestration (PS) is a rare congenital lung anomaly with anomalous systemic arterial supply. Surgical resection is the standard treatment, but some children have contraindications. Endovascular embolization (EE) is an established alternative; published pediatric experience is limited, particularly in neonates. We report a two-centre experience with extended follow-up and quantitative hemodynamic data. Methods: Six pediatric patients (five male; median age 6 months, range 11 days to 4 years and 8 months) underwent EE for PS at two centres in Gda\u0144sk, Poland, between 2020 and 2025. Contraindications to surgery were severe pulmonary arterial hypertension, high-output cardiac failure, low body weight with comorbidity, complex extralobar anatomy or refused parental consent. Procedures were performed under general anesthesia via right common femoral arterial access; device strategy was tailored to vessel anatomy. Results: Technical success was 100% with no procedural complications. Median feeding-artery diameter was 3.4 mm (range 2.1 to 5.3 mm). An Amplatzer-family vascular plug was used in five patients (83.3%), pushable platinum coils in two (33.3%) and Onyx-18 in one (16.7%); two had hybrid combinations and one underwent planned staged two-step embolization. Median procedural duration was 51 min. At median follow-up of 50 months (range 11 to 68), all patients showed sequester regression on imaging. Reverse cardiac remodelling occurred within five weeks in the patient with pre-procedural left ventricular dilation (Z-score +2.45 returning to normal); systolic pulmonary artery pressure fell from 35 to 40 to 17 mmHg within six weeks in the neonate treated at 11 days of life for high-output cardiac failure. No patient required surgical resection. Conclusions: Endovascular embolization is safe and effective in pediatric patients with pulmonary sequestration and contraindications to surgery, including neonates with comorbidity. Documented reverse cardiac remodelling and rapid hemodynamic improvement support its use in selected cases.<\/jats:p>","DOI":"10.3390\/children13060842","type":"journal-article","created":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T08:43:57Z","timestamp":1782463437000},"page":"842","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Endovascular Embolization of Pulmonary Sequestration in Children with Contraindications to Surgery: A Two-Centre Experience with Long-Term Follow-Up"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5539-4903","authenticated-orcid":false,"given":"Marcin","family":"Losin","sequence":"first","affiliation":[{"name":"Department of Surgery and Urology for Children and Adolescents, Medical University of Gda\u0144sk, ul. Smoluchowskiego 17, 80-214 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maciej","family":"Chojnicki","sequence":"additional","affiliation":[{"name":"Laboratory of Pediatric Interventional Cardiology, St. Adalbert Hospital, COPERNICUS, 80-803 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weronika","family":"Lotkowska","sequence":"additional","affiliation":[{"name":"Department of Surgery and Urology for Children and Adolescents, Medical University of Gda\u0144sk, ul. Smoluchowskiego 17, 80-214 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9377-8094","authenticated-orcid":false,"given":"Ewelina","family":"Wojciechowska","sequence":"additional","affiliation":[{"name":"Department of Surgery and Urology for Children and Adolescents, Medical University of Gda\u0144sk, ul. Smoluchowskiego 17, 80-214 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1152-2659","authenticated-orcid":false,"given":"Maciej","family":"Murawski","sequence":"additional","affiliation":[{"name":"Department of Surgery and Urology for Children and Adolescents, Medical University of Gda\u0144sk, ul. Smoluchowskiego 17, 80-214 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bartosz","family":"Regent","sequence":"additional","affiliation":[{"name":"Department of Radiology, Medical University of Gda\u0144sk, 80-210 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5266-8665","authenticated-orcid":false,"given":"Piotr","family":"Czauderna","sequence":"additional","affiliation":[{"name":"Department of Surgery and Urology for Children and Adolescents, Medical University of Gda\u0144sk, ul. Smoluchowskiego 17, 80-214 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1093\/ejcts\/ezy049","article-title":"Bronchopulmonary sequestrations in a paediatric centre: Ongoing practices and debated management","volume":"54","author":"Farmakis","year":"2018","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.clinimag.2020.11.040","article-title":"Pulmonary sequestration: What the radiologist should know","volume":"73","author":"Gabelloni","year":"2021","journal-title":"Clin. Imaging"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1038\/s41572-023-00470-1","article-title":"Congenital lung malformations","volume":"9","author":"Pederiva","year":"2023","journal-title":"Nat. Rev. Dis. Prim."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.rcl.2021.08.002","article-title":"Pediatric congenital lung malformations: Imaging guidelines and recommendations","volume":"60","author":"Tivnan","year":"2022","journal-title":"Radiol. Clin. N. Am."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"907","DOI":"10.1016\/j.clp.2022.08.003","article-title":"Management of congenital lung malformations","volume":"49","author":"Hegde","year":"2022","journal-title":"Clin. Perinatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"5153","DOI":"10.21037\/jtd.2017.10.145","article-title":"Retrospective review of the diagnosis and treatment of pulmonary sequestration in 28 patients: Surgery or endovascular techniques?","volume":"9","author":"Zhang","year":"2017","journal-title":"J. Thorac. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.arbr.2016.12.005","article-title":"Short-term outcome of percutaneous treatment of pulmonary sequestration in a pediatric hospital in the Andes: A case series","volume":"53","year":"2017","journal-title":"Arch. Bronconeumol."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Abu Zahira, I., Haddad, R.N., Meot, M., Bonnet, D., and Malekzadeh-Milani, S. (2023). Transcatheter management of pulmonary sequestrations in children\u2014A single-center experience. Children, 10.","DOI":"10.3390\/children10071197"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e220204","DOI":"10.1148\/rg.220204","article-title":"Transarterial embolization of pulmonary sequestration [Letter to the Editor]","volume":"43","author":"Saxena","year":"2023","journal-title":"Radiographics"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"240254","DOI":"10.1183\/16000617.0254-2024","article-title":"Risk of malignant transformation and infections in congenital lung malformations in adults: A systematic review","volume":"34","author":"Pederiva","year":"2025","journal-title":"Eur. Respir. Rev."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1089\/lap.2020.0596","article-title":"Thoracoscopic management of pediatric patients with congenital lung malformations: Results of a European multicenter survey","volume":"31","author":"Esposito","year":"2021","journal-title":"J. Laparoendosc. Adv. Surg. Tech. A"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1053\/j.sempedsurg.2017.09.001","article-title":"Long-term outcomes of congenital lung malformations","volume":"26","author":"Hall","year":"2017","journal-title":"Semin. Pediatr. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e000748","DOI":"10.1136\/wjps-2023-000748","article-title":"Efficacy of robot-assisted thoracoscopic surgery in the treatment of pulmonary sequestration in children","volume":"7","author":"Liang","year":"2024","journal-title":"World J. Pediatr. Surg."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/6\/842\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T10:24:43Z","timestamp":1782469483000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/6\/842"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,22]]},"references-count":13,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["children13060842"],"URL":"https:\/\/doi.org\/10.3390\/children13060842","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,22]]}}}