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Stern J, Khalil A, Roussel A, P M. WHOLE-LUNG torsion following bilateral lung transplant, a rare complication: A case report. Heliyon 2024; 10:e31491. [PMID: 38831818 PMCID: PMC11145471 DOI: 10.1016/j.heliyon.2024.e31491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 05/16/2024] [Accepted: 05/16/2024] [Indexed: 06/05/2024] Open
Abstract
Whole lung torsion following bilateral lung transplant is a rare complication. This case report describes the diagnostic difficulties and consequences in a 59 year old patient. This study also includes a brief description of other cases in the literature.
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Affiliation(s)
- J. Stern
- Department of Anesthesiology and Critical Care Medecine, Bichat-Claude Bernard University Hospital, Paris, France
| | - A. Khalil
- Department of Radiology, Assistance Publique Hopitaux de Paris, Bichat-Claude Bernard University Hospital, Paris, France
| | - A. Roussel
- Department of Thoracic and Vascular Surgery, Assistance Publique Hopitaux de Paris, Bichat-Claude Bernard University Hospital, Paris, France
| | - Montravers P
- Department of Anesthesiology and Critical Care Medecine, Bichat-Claude Bernard University Hospital, Paris, France
- Inserm UMR 1152, Physiopathologie et Epidémiologie des Maladies Respiratoires, Paris, France
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2
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Jiang H, Han Y, Zheng X, Fang Q. Roles of electrical impedance tomography in lung transplantation. Front Physiol 2022; 13:986422. [PMID: 36407002 PMCID: PMC9669435 DOI: 10.3389/fphys.2022.986422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022] Open
Abstract
Lung transplantation is the preferred treatment method for patients with end-stage pulmonary disease. However, several factors hinder the progress of lung transplantation, including donor shortages, candidate selection, and various postoperative complications. Electrical impedance tomography (EIT) is a functional imaging tool that can be used to evaluate pulmonary ventilation and perfusion at the bedside. Among patients after lung transplantation, monitoring the graft’s pulmonary function is one of the most concerning issues. The feasible application of EIT in lung transplantation has been reported over the past few years, and this technique has gained increasing interest from multidisciplinary researchers. Nevertheless, physicians still lack knowledge concerning the potential applications of EIT in lung transplantation. We present an updated review of EIT in lung transplantation donors and recipients over the past few years, and discuss the potential use of ventilation- and perfusion-monitoring-based EIT in lung transplantation.
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Affiliation(s)
| | | | - Xia Zheng
- *Correspondence: Xia Zheng, ; Qiang Fang,
| | - Qiang Fang
- *Correspondence: Xia Zheng, ; Qiang Fang,
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3
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Loor G, Mattar A, Schaheen L, Bremner RM. Surgical Complications of Lung Transplantation. Thorac Surg Clin 2022; 32:197-209. [PMID: 35512938 DOI: 10.1016/j.thorsurg.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Lung transplantation is a life-saving intervention and the most effective therapy for select patients with irreversible lung disease. Despite the effectiveness of lung transplantation, it is a major operation with several opportunities for complications. For example, recipient and donor factors, technical issues, early postoperative events, and immunology can all contribute to potential complications. This article highlights some of the key surgery-related complications that can undermine a successful lung transplantation. The authors offer their expert opinion and experience to help practitioners avoid such complications and recognize and treat them early should they occur.
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Affiliation(s)
- Gabriel Loor
- Department of Surgery and Baylor Lung Institute, Baylor College of Medicine, One Baylor Plaza, MS: BCM390, Houston, TX 77030, USA; Division of Cardiothoracic Transplantation and Circulatory Support, Texas Heart Institute, 6720 Bertner Avenue Suite C355K, Houston, TX 77030, USA.
| | - Aladdein Mattar
- Department of Surgery and Baylor Lung Institute, Baylor College of Medicine, One Baylor Plaza, MS: BCM390, Houston, TX 77030, USA
| | - Lara Schaheen
- Norton Thoracic Institute, St. Joseph's Medical Center, 500 W Thomas Rd Ste 500, Phoenix, AZ 85013, USA; Creighton University School of Medicine-Phoenix Regional Campus, 350 W. Thomas Rd, Phoenix, AZ 85013, USA
| | - Ross M Bremner
- Norton Thoracic Institute, St. Joseph's Medical Center, 500 W Thomas Rd Ste 500, Phoenix, AZ 85013, USA; Creighton University School of Medicine-Phoenix Regional Campus, 350 W. Thomas Rd, Phoenix, AZ 85013, USA
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4
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Liu D, Nagle SK, Kleedehn MG. Left upper lobe and lingula torsion after transplantation of single lung with complete major and minor fissures: A case report. Clin Imaging 2022; 84:79-83. [PMID: 35151130 DOI: 10.1016/j.clinimag.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/24/2022] [Accepted: 01/24/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Native lung torsion is rare and torsion in a lung transplant is even rarer. CASE PRESENTATION Here we report a case of left upper lobe (LUL) and lingula torsion in a patient with a unilateral left lung transplantation. The transplant was complicated by a graft with a short pulmonary artery cuff, which required significant vascular reconstruction and manipulation. Additionally, the graft had complete left major and minor fissures, which are documented risk factors for torsion. After 24 h postoperatively, the patient failed to wean off ventilation. The patient was worked up with bronchoscopy, a computed tomography (CT), and a CT angiogram (CTA). A CT without intravenous (IV) contrast showed the findings suggestive of torsion of the LUL and lingula and the CTA confirmed the diagnosis. Immediate re-exploration was performed for detorsion to preserve the vitality of the allograft. Following the failed detorsion, the patient had re-transplantation of the left lung with good results. CONCLUSION Lung torsion should be watched for in patients with major risk factors like complete fissure. CT and/or CTA are effective tools to confirm the diagnosis.
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Affiliation(s)
- Daniel Liu
- University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Ave., Madison, WI 53705, United States.
| | - Scott K Nagle
- Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Ave., Madison, WI 53705, United States.
| | - Mark G Kleedehn
- Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Ave., Madison, WI 53705, United States.
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Yang SM, Huang SC, Kuo SW, Huang PM, Hsiao PN, Chen KC, Lin MW, Pan SC, Lin JH, Cheng YJ, Lee JM, Hsu HH. Twenty-years of lung transplantation in Taiwan: Effects of cumulative institutional experience on early outcomes. J Formos Med Assoc 2017; 116:862-868. [PMID: 28958705 DOI: 10.1016/j.jfma.2017.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 08/04/2017] [Accepted: 08/29/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/PURPOSE Lung transplantation in Taiwan began in 1991, but the experience was limited and diverse in the early years. We examined the cumulative institutional experience of the largest lung transplant cohort in Taiwan. METHODS A retrospective review of lung transplantations performed at a single institution from December 1995 through August 2016 was conducted. For comparative purposes, the cohort was divided into halves, with an early group (undergoing lung transplantation in the first decade) vs a late group (undergoing lung transplantation in the second decade). Standardized donor selection, organ procurement, and preservation protocols for brain-dead donors were applied. The outcomes measured were 30-day mortality and actuarial survival using the Kaplan-Meier method. RESULTS The cohort included 50 recipients in the early group and 42 recipients in the late group. Compared with the early group, recipients in the late group were significantly older (38.8 ± 11.6 vs 44.8 ± 13.4 years, p = 0.024) and more of them required mechanical ventilation before transplant (26.0% vs 66.7%, p < 0.001). There were more female donors (12.0% vs 33.3%, p = 0.021) and gender-matched donors (34.0% vs 61.9%, p = 0.012) in the late group. A total of 87 recipients (94.6%) had cardiopulmonary bypass (CPB) or extracorporeal membrane oxygenation (ECMO) support during transplant, and CPB was used significantly less in the late group. Graft procedures (14.0% vs 47.6%, p < 0.001), delayed chest closure (0% vs 21.4%, p < 0.001), and early tracheostomy (24.0% vs 52.4%, p = 0.005) were performed more in the late group. The durations of hospital and ICU stays were comparable in both groups, but the 30-day mortality was significantly lower in the late group (30.0% vs 2.4%, p = 0.001). CONCLUSION Although the results were undesirable in the first decade of the transplant program, the cumulative institutional experience led to significantly improved outcomes in the second decade of the transplant program.
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Affiliation(s)
- Shun-Mao Yang
- Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan; Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taiwan
| | - Shu-Chien Huang
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taiwan
| | - Shuenn-Wen Kuo
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taiwan
| | - Pei-Ming Huang
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taiwan
| | - Po-Ni Hsiao
- Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taiwan
| | - Ke-Cheng Chen
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taiwan
| | - Mong-Wei Lin
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taiwan
| | - Sung-Ching Pan
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taiwan
| | - Jui-Hsiang Lin
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan
| | - Ya-Jung Cheng
- Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taiwan
| | - Jang-Ming Lee
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taiwan
| | - Hsao-Hsun Hsu
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taiwan.
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6
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Tejwani V, Panchabhai TS, Kotloff RM, Mehta AC. Complications of Lung Transplantation. Chest 2016; 149:1535-45. [DOI: 10.1016/j.chest.2015.12.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 11/16/2015] [Accepted: 12/11/2015] [Indexed: 01/30/2023] Open
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7
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Cox CS, Decker SJ, Rolfe M, Hazelton TR, Rojas CA. Middle Lobe Torsion after Unilateral Lung Transplant. J Radiol Case Rep 2016; 10:15-21. [PMID: 27761176 DOI: 10.3941/jrcr.v10i5.2761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Lobar torsion is well documented after pneumonectomy, but is very rare after lung transplant. To the best of our knowledge, this is the twelfth reported case of lobar torsion after lung transplant. In our case, bronchoscopies and chest radiographs were inconclusive; however, CT scan clearly demonstrated findings consistent with right middle lobe torsion. We review the literature and discuss the epidemiology, clinical presentation, imaging features, and treatment considerations for this condition. We also propose that if a clinical picture could be secondary to torsion and bronchoscopies and chest x ray are inconclusive that a CT scan should be obtained as soon as possible since early recognition increases the likelihood of being able to successfully detorse the lung and avoid lobectomy.
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Affiliation(s)
- Chad S Cox
- Department of Radiology, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Summer J Decker
- Department of Radiology, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Mark Rolfe
- Department of Pulmonology and Critical Care, Tampa General Hospital, Tampa, USA
| | - Todd R Hazelton
- Department of Radiology, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Carlos A Rojas
- Department of Radiology, University of South Florida Morsani College of Medicine, Tampa, USA
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8
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Reed H, Janelle GM. A Single-Lung Transplantation Complicated by Torsion of the Donor Lung: Diagnosis by Intraoperative Transesophageal Echocardiography. J Cardiothorac Vasc Anesth 2016; 30:716-9. [PMID: 26748975 DOI: 10.1053/j.jvca.2015.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Heather Reed
- Department of Anesthesiology, University of Florida, Gainesville, FL
| | - Gregory M Janelle
- Department of Anesthesiology, University of Florida, Gainesville, FL.
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9
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Stephens G, Bhagwat K, Pick A, McGiffin D. Lobar Torsion Following Bilateral Lung Transplantation. J Card Surg 2014; 30:209-14. [DOI: 10.1111/jocs.12476] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Georgina Stephens
- Department of Cardiothoracic Surgery; Alfred Hospital; Melbourne Victoria Australia
| | - Krishna Bhagwat
- Department of Cardiothoracic Surgery; Alfred Hospital; Melbourne Victoria Australia
| | - Adrian Pick
- Department of Cardiothoracic Surgery; Alfred Hospital; Melbourne Victoria Australia
| | - David McGiffin
- Department of Cardiothoracic Surgery; Alfred Hospital; Melbourne Victoria Australia
- Monash University; Melbourne Victoria Australia
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