1
|
Jing L, Chen W, Zhai Z, Pan X, Tao X, Cao L, Zhao L, Guo L, Liang C, Chen J, Wang C. Pulmonary vein stenosis after lung transplantation: a case report and literature review. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:181. [PMID: 33569483 PMCID: PMC7867883 DOI: 10.21037/atm-20-3972] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Pulmonary vein stenosis (PVS) is a rare event following lung transplantation which increases the risk of morbidity and mortality. Early detection and rapid treatment of this condition is crucial for its management. Although several reports on PVS have been published, there is little consensus regarding its diagnosis and the methods of management. Here we present our experience with PVS. A 31-year-old man received a left lung transplant for chronic hypersensitivity pneumonitis. One year after his single-lung transplant, he began to develop persistent progressive hypoxemia. Computed tomography (CT) of the chest showed left pleural effusion and thickening of the interlobular septa. The results of bronchoscopy and transbronchial biopsies excluded the possibility of acute rejection or infection. The pleural effusion was transudative with lymphocyte predominance. Computed tomography angiography (CTA) in the left atrium and pulmonary veins demonstrated obvious stenosis of both the upper and lower left pulmonary veins (LLPVs) at the transplant anastomotic site. The patient underwent a catheter-guide stent implantation into the stenotic segment of the upper left pulmonary vein (ULPV), and his pleural effusion and hypoxemia problems were ameliorated. Ten months after the intervention, the patient was in excellent clinical condition. In a literature review, we discuss the importance of identifying PVS early after transplantation, the utility of CTA for diagnosis and the use of pulmonary vein stenting intervention. This review provides a basis for further diagnostic strategies and treatments for PVS following lung transplantation.
Collapse
Affiliation(s)
- Lei Jing
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Lung Transplantation, Centre for Lung Transplantation, Centre for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Wenhui Chen
- Department of Lung Transplantation, Centre for Lung Transplantation, Centre for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Zhenguo Zhai
- Department of Respiratory and Critical Care Medicine, Centre for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Xin Pan
- Department of Cardiology, Shanghai Chest Hospital, Shanghai, China
| | - Xincao Tao
- Department of Respiratory and Critical Care Medicine, Centre for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Lei Cao
- Department of Lung Transplantation, Centre for Lung Transplantation, Centre for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Li Zhao
- Department of Lung Transplantation, Centre for Lung Transplantation, Centre for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Lijuan Guo
- Department of Lung Transplantation, Centre for Lung Transplantation, Centre for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Chaoyang Liang
- Department of Lung Transplantation, Centre for Lung Transplantation, Centre for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Jingyu Chen
- Department of Lung Transplantation, Centre for Lung Transplantation, Centre for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Chen Wang
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Lung Transplantation, Centre for Lung Transplantation, Centre for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| |
Collapse
|
2
|
Abstract
The pulmonary veins (PVs) are the most proximal source of arterial thromboembolism. Pulmonary vein thrombosis (PVT) is a rare but potentially lethal disease; its incidence is unclear, as most of the literature includes case reports. It most commonly occurs as a complica-tion of malignancy, post lung surgery, or atrial fibrillation and can be idiopathic in some cases. Most patients with PVT are commonly asymptomatic or have nonspecific symptoms such as cough, hemoptysis, and dyspnea from pulmonary edema or infarction. The thrombi are typically detected using a variety of imaging modalities including transesophageal echocardiogram (TEE), computed tomography (CT) scanning, magnetic resonance imaging (MRI), or pulmonary angiog-raphy. Treatment should be determined by the obstructing pathological finding and can include antibiotic therapy, anticoagulation, thrombectomy, and/or pulmonary resection. The delay in diagnosing this medical entity can lead to complications including pulmonary infarction, pulmonary edema, right ventricular failure, allograft failure, and peripheral embolism resulting in limb ischemia, stroke, and renal infarction (RI).
Collapse
Affiliation(s)
- Gerard Chaaya
- Internal Medicine, University of Central Florida College of Medicine
| | | |
Collapse
|
3
|
Abstract
AIM The aim of this article is to impart knowledge concerning focused transesophageal echocardiographic examination (TEE) for non-cardiac surgery which is an essential part of perioperative monitoring. It allows a rapid echocardiographic examination without interference with the surgical field or under limited transthoracic examination conditions. New recommendations for a comprehensive perioperative TEE examination with expanded standard views and the recently published consensus statement for a shortened baseline examination were crucial for this study. MATERIAL AND METHODS The background is the peer-reviewed literature from PubMed. RESULTS Apart from cardiac surgery TEE has two main applications: firstly, the evaluation of patients developing acute life-threatening hemodynamic instability in the operating room, in the emergency room or in the intensive care unit (ICU). Secondly, TEE is used as planned intraoperative monitoring when severe hemodynamic, pulmonary or neurological complications are expected because of the type of surgery or due to the cardiopulmonary medical history of the patient. In 2013 a total of 11 relevant standard views were defined for the basic perioperative TEE examination in non-cardiac surgery. These 11 views should be performed for each patient. Appropriate extension to a comprehensive examination may be necessary if complex pathology is obvious. DISCUSSION Even in non-cardiac surgery TEE is an important tool allowing clarification of a life-threatening perioperative hemodynamic instability within a few minutes. Furthermore, the hemodynamic management of high-risk patients can be facilitated. Appropriate qualification and continuous training are necessary in order to assure the competence of the examiner.
Collapse
|
4
|
Catena E, Paino R, Fieschi S, Rinaldo A, Milazzo F, Dejuli E, Ravini M. Lung Transplantation and Pulmonary Vein Thrombosis: A Possible Role of Epicardial Echocardiography. J Cardiothorac Vasc Anesth 2008; 22:167-8. [DOI: 10.1053/j.jvca.2007.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2006] [Indexed: 11/11/2022]
|
5
|
Chang YY, Chang CI, Wang MJ, Lin SM, Chen YS, Tsai SK, Lue HC. The safe use of intraoperative transesophageal echocardiography in the management of total anomalous pulmonary venous connection in newborns and infants: a case series. Paediatr Anaesth 2005; 15:939-43. [PMID: 16238553 DOI: 10.1111/j.1460-9592.2005.01570.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Intraoperative transesophageal echocardiography (TEE) is useful in evaluating the repair of lesions in patients with congenital heart disease. But the use of TEE in infants with total anomalous pulmonary venous connection (TAPVC) remains unclear. We reviewed the safety and efficacy of intraoperative TEE during TAPVC repair. METHODS Twenty-eight consecutive 1 day to 7 month-old infants with TAPVC (14 supracardiac, six intracardiac and eight infracardiac type) had surgical repair with intraoperative TEE monitoring. RESULTS Four patients received immediate surgical revision after primary surgery for residual anastomotic stenosis diagnosed by TEE. In addition, two unsuspected ventricular septal defects and three persistent ductus arteriosus were detected before surgery. Eight infants (29%) had hypotension and hypoxemia associated with TEE probe insertion before surgery, but this hemodynamic disturbance returned to baseline value after withdrawing the TEE probe from the esophagus. However, these eight patients had uneventful TEE probe insertion following sternotomy. The mechanism was probably because of the reduction of intrathoracic pressure when the chest was opened. CONCLUSIONS TEE probe insertion in TAPVC patients may pose a potential risk of compression of pulmonary venous confluence resulting in hemodynamic instability. Therefore, we suggest that the use of TEE in such TAPVC patients appears to be safer after sternotomy.
Collapse
Affiliation(s)
- Ya-Ying Chang
- Department of Anesthesiology, National Taiwan University, Pei-tou, Taipei, Taiwan
| | | | | | | | | | | | | |
Collapse
|
6
|
Mergner D, Rosenberger P, Unertl K, Eltzschig HK. [Preoperative evaluation and perioperative management of patients with increased cardiovascular risk]. Anaesthesist 2005; 54:427-41. [PMID: 15815886 DOI: 10.1007/s00101-005-0846-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Due to the increasing age in western countries, combined with high rates of major surgical interventions in high-risk patients, perioperative reduction of cardiovascular complications becomes increasingly more important for perioperative physicians. After identifying patients with increased perioperative risk, specific interventions need to be considered to reduce their risk for cardiovascular complications, either by perioperative medical therapy or specific treatment options (e.g. coronary intervention). Several trials have demonstrated an effect of perioperative beta-blocker-therapy in reducing cardiovascular complications among high-risk patients. Additionally, several monitoring techniques are effective in detecting cardiovascular complications. Nevertheless, it remains unclear whether they are associated with a measurable improvement of outcome. Based on the ACC/AHA-guidelines, the present review describes a stepwise approach to surgical patients to identify perioperative risks, based on specific patient related risk factors, the kind of surgery and on the specific setting (emergency versus elective surgery). In addition, strategies to reduce perioperative cardiovascular complications are discussed.
Collapse
Affiliation(s)
- D Mergner
- Abteilung für Anästhesiologie und Intensivmedizin, Universitätsklinikum, Tübingen
| | | | | | | |
Collapse
|