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Zheng Q, Shang X, Dong N, Shi J. A stent for branch pulmonary artery stenosis after double-lung transplantation in a patient with COVID-19: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytab327. [PMID: 34703978 PMCID: PMC8542464 DOI: 10.1093/ehjcr/ytab327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/10/2020] [Accepted: 08/05/2021] [Indexed: 11/30/2022]
Abstract
Background Coronavirus disease 2019 (COVID-19) continues to be a pandemic worldwide. Lung transplantation is the last option to increase life expectancy of end-stage COVID-19 patients. Branch pulmonary artery stenosis (PAS) is a rare complication after lung transplantation with an extremely poor prognosis. The current trend in the management of branch PAS is percutaneous balloon angioplasty and/or stent implantation, rather than high-risk reoperation with a lower success rate. Case summary The subject was a 54-year-old male with severe acute respiratory syndrome coronavirus 2 infection who underwent a double-lung transplantation. He suffered hypoxaemia and right heart dysfunction following the operation. Right cardiac catheterization and pulmonary angiography examination revealed severe stenosis of the right branch pulmonary artery. Due to immunosuppression and reduced coagulation function, the patient underwent pulmonary artery balloon dilatation and stent implantation, and ultimately recovered well. Discussion The combination of balloon dilatation and stent implantation is a good alternative to reoperation for patients with COVID-19.
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Affiliation(s)
- Qiang Zheng
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei 430022, China
| | - Xiaoke Shang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei 430022, China
| | - Nianguo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei 430022, China
| | - Jiawei Shi
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei 430022, China
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Kumar N, Hussain N, Kumar J, Essandoh MK, Bhatt AM, Awad H, Perez WJ, Whitson BA, Ganapathi AM, Mokadam NA, Gorelik L, Turner K, Iyer MH. Evaluating the Impact of Pulmonary Artery Obstruction After Lung Transplant Surgery: A Systematic Review and Meta-analysis. Transplantation 2021; 105:711-722. [PMID: 33760790 DOI: 10.1097/tp.0000000000003407] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Pulmonary artery obstruction is an uncommon but significant complication after lung transplantation. Although numerous reports have documented its occurrence, the hemodynamic parameters associated with its presentation and diagnostic considerations remain ill-defined. This systematic review summarizes evidence in the literature surrounding pulmonary artery obstruction after lung transplantation surgery. METHODS Databases were searched for all articles and abstracts reporting on pulmonary artery obstruction. Data collected included the number of patients studied, patient characteristics, incidences of pulmonary artery obstruction, and timing and imaging modality used for diagnosis. RESULTS Thirty-four full-text citations were included in this review. The point prevalence of pulmonary artery obstruction was 3.66%. The peak pulmonary artery velocity associated with obstruction was found to be 2.60 ± 0.58 m/s. The diameter of the obstructed pulmonary artery predictive of poor outcomes was noted to be 0.78 ± 0.40 cm. The majority of diagnoses were made in the late postoperative period using pulmonary angiogram and transesophageal echocardiography. Overall, 76% of patients (47 of 62) required emergent procedural reintervention, and 23% of patients (14 of 62) diagnosed with pulmonary artery obstruction died during their hospital stay. CONCLUSIONS This systematic review underscores the importance of identifying pulmonary artery obstruction immediately after lung transplant surgery. The clinical implications of these results warrant the development of identification and management strategies for early detection of irregularities in pulmonary artery anastomosis in lung transplant patients.
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Affiliation(s)
- Nicolas Kumar
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Nasir Hussain
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Julia Kumar
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Michael K Essandoh
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Amar M Bhatt
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Hamdy Awad
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - William J Perez
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Bryan A Whitson
- Division of Cardiac Surgery, Department of Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Asvin M Ganapathi
- Division of Cardiac Surgery, Department of Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Nahush A Mokadam
- Division of Cardiac Surgery, Department of Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Leonid Gorelik
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Katja Turner
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Manoj H Iyer
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Columbus, OH
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3
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Successful angioplasties using high pressure large balloons in a patient with severe anastomotic pulmonary artery stenosis soon after single-lung transplantation. J Cardiol Cases 2020; 22:22-25. [PMID: 32636964 DOI: 10.1016/j.jccase.2020.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 03/06/2020] [Accepted: 03/30/2020] [Indexed: 11/21/2022] Open
Abstract
A 59-year-old man received a single-lung transplantation due to interstitial pneumonitis. Severe anastomotic pulmonary artery stenosis (PAS) resulting in hypoxia and respiratory symptoms was found in the immediate postoperative period. A scintigraphy showed severe hypoperfusion of the left transplanted lung with 7% of the total pulmonary blood flow. On postoperative days (POD) 29 and 64, the patient underwent serial balloon angioplasties without any complications. Based on the balloon selection criteria for PAS after heart surgery in children, a high-pressure large balloon was used with resultant improvement in respiratory signs and symptoms without any complications. The patient was discharged on POD 92. A follow-up scintigraphy on POD 169 revealed 58% of blood distribution to the left lung. The patient has been doing clinically well and remained asymptomatic one year after the transplantation. Balloon angioplasty with a high-pressure large balloon without stent implantation during an early postoperative period may be a safe and effective strategy. The balloon selecting criteria used in pediatric patients may be applied in the adult lung transplant recipients. <Learning objective: Anastomotic pulmonary artery stenosis (PAS) in a single-lung transplant recipient is a critical complication. A balloon angioplasty with a high-pressure large balloon should be a first choice for anastomotic PAS, because it is safer than stent implantation especially for transplant recipients. And the balloon selecting criteria used in children with congenital heart disease may be applied in the adult lung transplant recipients.>.
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Jobanputra YB, Kapadia SR, Johnston DR, Ahmed V, Jones BM, Budev M, Lane CR, Mehta AC. Pulmonary Vein Stenosis Following Single-Lung Transplantation Successfully Treated with Intravascular Ultrasound-Guided Angioplasty and Stent Placement. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:1289-1295. [PMID: 29203761 PMCID: PMC5726145 DOI: 10.12659/ajcr.905726] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Female, 60 Final Diagnosis: Pulmonary vein stenosis following single lung transplant Symptoms: Dyspnea on exertion and dry cough Medication: — Clinical Procedure: Balloon angioplasty and stenting of the left common pulmonary vein Specialty: Cardiology
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Affiliation(s)
- Yash B Jobanputra
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, USA
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, USA
| | - Douglas R Johnston
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, USA
| | - Vaseem Ahmed
- Department of Hospital Medicine, Medicine Institute, Cleveland Clinic, Cleveland, USA
| | - Brandon M Jones
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, USA
| | - Marie Budev
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, USA
| | - Charles Randall Lane
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, USA
| | - Atul C Mehta
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, USA
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Copelan A, George D, Kapoor B, Nghiem HV, Lorenz JM, Erly B, Wang W. Iatrogenic-related transplant injuries: the role of the interventional radiologist. Semin Intervent Radiol 2015; 32:133-55. [PMID: 26038621 DOI: 10.1055/s-0035-1549842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
As advances in surgical techniques and postoperative care continue to improve outcomes, the use of solid organ transplants as a treatment for end-stage organ disease is increasing. With the growing population of transplant patients, there is an increasing need for radiologic diagnosis and minimally invasive procedures for the management of posttransplant complications. Typical complications may be vascular or nonvascular. Vascular complications include arterial stenosis, graft thrombosis, and development of fistulae. Common nonvascular complications consist of leaks, abscess formation, and stricture development. The use of interventional radiology in the management of these problems has led to better graft survival and lower patient morbidity and mortality. An understanding of surgical techniques, postoperative anatomy, radiologic findings, and management options for complications is critical for proficient management of complex transplant cases. This article reviews these factors for kidney, liver, pancreas, islet cell, lung, and small bowel transplants.
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Affiliation(s)
- Alexander Copelan
- Department of Diagnostic Radiology, William Beaumont Hospital, Royal Oak, Michigan
| | - Daniel George
- Department of Diagnostic Radiology, William Beaumont Hospital, Royal Oak, Michigan
| | - Baljendra Kapoor
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
| | - Hahn Vu Nghiem
- Department of Diagnostic Radiology, William Beaumont Hospital, Royal Oak, Michigan
| | - Jonathan M Lorenz
- Section of Interventional Radiology, The University of Chicago, Chicago, Illinois
| | - Brian Erly
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio ; Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Weiping Wang
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
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Anaya-Ayala JE, Loebe M, Davies MG. Endovascular management of early lung transplant-related anastomotic pulmonary artery stenosis. J Vasc Interv Radiol 2015; 26:878-82. [PMID: 25851200 DOI: 10.1016/j.jvir.2015.02.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 02/16/2015] [Accepted: 02/18/2015] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To report the safety and short-term efficacy of endovascular interventions for symptomatic lung transplant-related anastomotic pulmonary artery stenosis (PAS). MATERIALS AND METHODS From February 2008 to December 2011, 354 lung transplants were performed. Pulmonary arteriography was performed in 19 patients (63% men; age, 57 y ± 21, mean ± SD; seven double-lung transplants) because of respiratory decompensation (mean 6.7 mo after transplant). Seven arteriograms were normal, and 12 showed significant PAS. One patient (5%) underwent angioplasty alone, and 11 patients (57%) underwent stent placement. RESULTS All patients underwent general anesthesia, and femoral access was used for the intervention. Technical success was 100% in the 12 patients treated. Symptoms improved in all patients who underwent intervention, with resolution in 11 of 12 (92%). There were no major or minor complications. Three patients (16%) had recurrent symptoms after discharge secondary to chronic rejection or pneumonia. Two patients died as a result of sepsis and multiorgan failure at 2 days and 14 days, respectively, after undergoing only pulmonary arteriography. In-stent stenosis occurred in 1 (9%) patient who required additional stent placement. During a mean follow-up period of 11 months, the remaining stents were patent, and the patients were asymptomatic. CONCLUSIONS Endovascular stent placement provides an alternative to open repair for transplant-related anastomotic PAS. It has low mortality and morbidity rates, and it has shown excellent short-term functional and anatomic outcomes.
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Affiliation(s)
- Javier E Anaya-Ayala
- Department of Cardiovascular Surgery, Houston Methodist Hospital, 6550 Fannin Street, Houston, TX 77030..
| | - Matthias Loebe
- Department of Cardiovascular Surgery, Houston Methodist Hospital, 6550 Fannin Street, Houston, TX 77030
| | - Mark G Davies
- Department of Cardiovascular Surgery, Houston Methodist Hospital, 6550 Fannin Street, Houston, TX 77030
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Grubstein A, Atar E, Litvin S, Belenky A, Knizhnik M, Medalion B, Raviv Y, Kramer MR, Fox BD. Angioplasty Using Covered Stents in Five Patients With Symptomatic Pulmonary Artery Stenosis After Single-Lung Transplantation. Cardiovasc Intervent Radiol 2014; 37:686-90. [DOI: 10.1007/s00270-013-0758-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 09/06/2013] [Indexed: 11/30/2022]
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Siddique A, Bose AK, Özalp F, Butt TA, Muse H, Morley KE, Dark JH, Parry G, Clark SC. Vascular anastomotic complications in lung transplantation: a single institution's experience. Interact Cardiovasc Thorac Surg 2013; 17:625-31. [PMID: 23788195 DOI: 10.1093/icvts/ivt266] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Lung transplant recipients were reviewed to compare our early and current experience of vascular complications. Since 1995, we have had a policy of early identification and intervention. METHODS We undertook a retrospective review of all adult lung transplants performed at our centre. Patients with pulmonary vascular complications before and after 1995 were identified and reviewed to determine changes in management and outcome. RESULTS We identified a total of 13 patients with either pulmonary artery or venous obstruction out of a total of 720 adult lung transplants (1.8%). There were 9 females and 4 males with an age range of 25-64 years. Complications were more common in patients with fibrotic lung disease and involved 15 vascular anastomoses, most commonly the pulmonary arterial anastomosis. Prior to 1995, 5 cases were identified, all postoperatively. In this group, the mean time for identification of the complication was 9.4 (range 4-14) days. Only 1 patient survived to discharge. After 1995, vascular complications were identified intraoperatively in 4 cases and corrected immediately. Four cases were identified postoperatively (at <1-17 days) by a computed tomography pulmonary angiogram. Three were treated surgically within 24 h of diagnosis (using cardiopulmonary bypass with cold preservation). One patient was managed conservatively. Among patients identified after 1995, 5 survived to discharge. CONCLUSIONS Though rare, pulmonary vascular complications after lung transplantation carry high mortality. In our opinion, early identification and intervention improves outcome. Intraoperative assessment by pressure gradient measurement and transoesophageal echocardiography is recommended. Despite this, mortality remains high and prevention is better than cure.
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Affiliation(s)
- Aleem Siddique
- Department of Cardiothoracic Transplantation and Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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9
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Caruso S, Crino’ F, Milazzo M, Vitulo P, Bertani A, Marrone G, Mamone G, Maruzzelli L, Miraglia R, Carollo V, Luca A, Gridelli B. Thoracic complications following lung transplantation: 64-MDCT findings. Clin Transplant 2011; 25:673-84. [DOI: 10.1111/j.1399-0012.2011.01439.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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10
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Barr ML, Kawut SM, Whelan TP, Girgis R, Böttcher H, Sonett J, Vigneswaran W, Follette DM, Corris PA. Report of the ISHLT Working Group on Primary Lung Graft Dysfunction Part IV: Recipient-Related Risk Factors and Markers. J Heart Lung Transplant 2005; 24:1468-82. [PMID: 16210118 DOI: 10.1016/j.healun.2005.02.019] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2004] [Revised: 02/07/2005] [Accepted: 02/17/2005] [Indexed: 12/27/2022] Open
Affiliation(s)
- Mark L Barr
- University of Southern California, Los Angeles, California 90033, USA.
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Asato Y, Amemiya R, Kiyoshima M, Shioyama Y, Asato M. Pulmonary artery stenting for recurrent lung cancer after left pneumonectomy. Ann Thorac Surg 2002; 73:1962-4. [PMID: 12078804 DOI: 10.1016/s0003-4975(01)03626-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We present a case of a patient with stenosis of the pulmonary artery which was successfully treated by implantation of a vascular endoprosthesis. A 50-year-old man underwent left pneumonectomy for lung cancer. Eleven months later, a computed tomographic scan revealed a soft tissue mass in the mediastinum and there was severe stenosis of the remaining right main pulmonary artery. A self-expandable vascular endoprosthesis was implanted in the stenotic portion. We used percutaneous cardiopulmonary support (PCPS) during the procedure. We recommend the technique of pulmonary artery stenting using PCPS as efficacious and safe.
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Affiliation(s)
- Yuji Asato
- Department of Surgery, Ibaraki Prefectural Central Hospital and Cancer Center, Japan.
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12
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Abstract
Spiral computed tomographic (CT) angiography of the pulmonary circulation has emerged recently as a potential useful diagnostic method for the evaluation of the pulmonary circulation. As a minimally invasive examination, this technique is becoming widely available and has progressively replaced conventional and digital pulmonary angiography as the standard diagnostic imaging modality of the pulmonary circulation. The purpose of this review is to capture the current state of the art of the technical aspects of spiral CT angiography, with special emphasis on the post-processing techniques currently available. As CT is responsible for a considerable part of the medical radiation dose applied to the population, the current trends for dose saving will also be emphasized. With regard to the clinical applications of spiral CT angiography, its introduction into the diagnostic work-up of pulmonary embolism has considerably modified the diagnostic algorithms. Our 8-year review of the literature presented herein is expected to provide the readers with a basis for formulating an informed opinion on this topic. In addition, a large number of congenital and acquired disorders of the pulmonary circulation are also relevant to this technique, and these indications are discussed in the context of the corresponding therapeutic options. Owing to the multiple possibilities inherent to this technique, spiral CT has the potential for cost savings without reduction in image quality or diagnostic accuracy.
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Affiliation(s)
- M Remy-Jardin
- Department of Radiology, Hospital Calmette, Lille, France.
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13
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Slone RM, Gierada DS, Yusen RD. Preoperative and postoperative imaging in the surgical management of pulmonary emphysema. Radiol Clin North Am 1998; 36:57-89. [PMID: 9465868 DOI: 10.1016/s0033-8389(05)70007-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
For patients with emphysema, imaging studies have been useful for diagnostic purposes and for preoperative patient selection for surgical intervention, such as bullectomy, lung transplantation, and LVRS. Chest radiography is useful in evaluating hyperinflation. Inspiratory and expiratory films are used to estimate diaphragmatic excursion and air-trapping. CT scan is used to evaluate the anatomy and distribution of emphysema throughout the lungs, providing information clinically unobtainable by other means. Both imaging techniques are useful for detecting other disease processes. Radionuclide lung scanning also provides an estimate of target areas, volume occupying but nonfunctioning lung. Cohort studies utilizing these imaging techniques have demonstrated associations between preoperative characteristics and postoperative outcome. The imaging studies, especially the chest radiograph, have also played an important role in postoperative management. Many other imaging options are available, such as HRCT scan, quantitative CT scan, and single photon emission CT scan. Other techniques, such as MR imaging, may play a future role as well.
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Affiliation(s)
- R M Slone
- Mallinckrodt Institute of Radiology, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, Missouri, USA
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Abstract
Acquired or de novo vascular obstructions can adversely affect the outcomes of management algorithms for children with congenital heart lesions. Although surgical repair is frequently feasible, some acquired or congenital obstructions are difficult to address in the operating theater. Presented is the recent experience with endovascular stents to relieve such stenoses, and their impact on patient care.
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Affiliation(s)
- L N Benson
- Department of Pediatrics, The Hospital for Sick Children, The University of Toronto School of Medicine, Ontario, Canada
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Abstract
BACKGROUND The data on vascular anastomotic complications after single-lung and bilateral lung transplantation are scant. METHODS We reviewed the data on our patients having single and bilateral lung transplantation to examine our experience and management of vascular anastomotic complications. RESULTS We retrospectively identified 5 of 109 consecutive patients undergoing lung transplantation who had postoperative pulmonary arterial or venous obstruction. There were 4 women and 1 man (age range, 32 to 53 years). Three patients had left single-lung transplantation, 1 patient had right single-lung transplantation, and 1 patient underwent bilateral sequential lung transplantation. Complications comprised two right-sided and two left-sided pulmonary artery stenoses and one combined left pulmonary arterial and venous obstruction. Isotope perfusion scanning was used in 3 patients and suggested a vascular stenosis in all of them. Pulmonary angiography was used in each as a confirmatory test and to demonstrate anatomic details. Transesophageal echocardiography was used in 1 patient and did not detect a right pulmonary artery stenosis. One patient underwent revision of a pulmonary artery stenosis with a period of warm ischemia and subsequent fatal lung injury. Two revisions were undertaken on cardiopulmonary bypass with a cold blood flush to the transplanted lung. One venous anastomotic angioplasty with stent insertion was performed. Two patients died before treatment. All 5 patients died between 5 and 630 days postoperatively. CONCLUSIONS Vascular complications carry a high mortality. Reoperation, preferably using cardiopulmonary bypass and a cold blood flush technique to avoid further lung injury, is recommended. In high-risk patients, dilation or stent insertion can be considered.
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Affiliation(s)
- S C Clark
- Regional Cardiothoracic Centre, Freeman Hospital NHS Trust, Newcastle-upon-Tyne, England
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Abstract
Intravascular stent placement in Pediatric Cardiology has provided one of the most interesting and effective means of catheter treatment of congenital lesions. In the 5 years since it has been performed, balloon-expandable stent placement has provided relief of many previously untreatable vascular stenoses and has resulted in improvement of blood flow, reduction of right ventricular pressure and, in many cases, dramatic improvement of symptoms. In this article, the background of balloon-expandable stent placement is discussed, and specific observations are offered regarding the technique of implantation. The generally excellent results are presented and a number of novel problems and pitfalls are outlined. Finally, a brief summary of the wide ranging applicability of stent implantation is discussed, along with some of the important and imaginative new directions for the therapy.
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Affiliation(s)
- M P O'laughlin
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina 27710, USA
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