[The Kartagener syndrome]

A 25-year-old woman with Kartagener's syndrome was admitted to hospital for laparoscopy because of sterility. Kartagener's syndrome is a rare disorder involving the combination of situs inversus, bronchiectasis and sinusitis. A dynein deficiency leads to ciliary dyskinesia. When general anaesthesia is to be induced in a patient with Kartagener's syndrome the following points must be borne in mind: ascertainment of the preoperative pulmonary status, antibiotic coverage, recognition of dextrocardia, necessity for aseptic techniques because of the possibility of abnormal neutrophil chemotaxis. Anticholinergic and antitussive medications are relatively contraindicated, as are nasal tubes. In the present case an intubation anaesthesia with thiopental, nitrous oxide, enflurane and succinylcholine was carried out; cefoxitin was administered for antibiotic treatment, and the patient made an uneventful recovery.

Double lung transplantation in situs inversus with Kartagener's syndrome. Paris-Sud University Lung Transplant Group

En bloc double lung transplantation with bilateral bronchial anastomoses was successfully performed in three patients with complete situs inversus and end-stage Kartagener's syndrome. Dextrocardia was not a technical problem for institution of cardiopulmonary bypass, but a large azygos vein draining the systemic venous return was systematically preserved. The major technical difficulty was restoration of airway continuity, because patients with situs inversus have an inverse direction and length of the main stem bronchi. The right and left main bronchi of the recipients were approached in the aortocaval sinus and transected approximately at 1.5 cm from the carina. The donor right main stem bronchus was divided at its origin and the donor left main stem bronchus was divided proximal to the upper lobe takeoff. The different bronchial angulation was not an obstacle, and airway continuity was reestablished twice with an end-to-end anastomosis and once with a telescopic technique. Because of the midline position of the left atrium and pulmonary artery, the anastomoses with the respective recipient's structures were made as in patients with situs solitus. One patient required a right lower lobectomy because the position of the right side of the heart interfered with lobar expansion. One patient died of obliterative bronchiolitis 36 months after the operation. The remaining two are alive and doing well after 48 and 6 months, respectively.

Lung transplantation in Kartagener's syndrome

Kartagener's syndrome is associated with bronchiectasis and situs inversus and may offer an indication for lung transplantation. One case of heart and lung transplantation has been published that stresses the necessity for a modified surgical procedure creating a large single atrium to manage the situs inversus. We performed a double lung transplantation in a 46-year-old patient with this disease. No technical modifications for the different anatomic relationship were necessary; discrepancies of the bronchial lumina were easily overcome.

Heart-lung transplantation in situs inversus. A case report in a patient with Kartagener's syndrome

After a long history of recurrent chronic pulmonary infections in a 25-year-old woman with Kartagener's syndrome, a heart-lung transplantation was performed. A modified surgical procedure was needed to perform transplantation because of the presence of a situs inversus, which is usually associated with bronchiectasis and sinusitis in this congenital syndrome. A large single atrium was created with both the right and left recipient atria used to facilitate anastomosis with the donor's right atrium. The patient was discharged after resolution of early ventilatory complications and is in good condition 8 months after transplantation.

Kartagener's syndrome seen on CT

The authors present a case of Kartagener's syndrome that was seen on CT. To the authors' knowledge, this is the first reported case of such. The appearance and interesting aspects of the case will be described.

[Cartagener syndrome. Pathogenesis and therapy]

Kartagener's syndrome (situs inversus totalis, bronchiectasis and sinusitis) was demonstrated in two patients. Electron microscopic investigations of the bronchial epithelium showed an accidental arrangement of ciliary axes, but not the expected lack of dynein arms. In both cases severe disturbance of maturation of spermiogenesis, not noted in this syndrome so far, was observed. Whereas one patient is largely free of symptoms after two operations, the other died after the second operation as a consequence of bronchopleural fistulation and bilateral pneumonic complications.

Surgical treatment of bronchiectasis in Kartagener's syndrome

A case of Kartagener's syndrome in which bilateral partial pulmonary resection was performed is reported. The literature concerning the surgical treatment of severe bronchiectasis is reviewed.

[Kartagener's syndrome in childhood. Report of 2 cases]

Two cases of children with the syndrome (triad) of Kartagener are described. One of them presented two of the triad's components; the other one, probably complete, as a part of a partial revision of clinical charts, corresponding to children with "situs inversus", from 1970 to December 1973, at the Children's Hospital of Mexico. The literature is reviewed, concerning this unfrequently seen entity, finding a great majority of reports in children, less than 14 years old, a positive family history and serious respiratory disease complications on those affected. It is important to understand the early diagnosis and treatment of these patients, mainly if they have upper respiratory disease, to avoid future onset of bronchiectasis. The genetical aspects, as well as variable clinical affections are mentioned.