DOUBLE-LUNG TRANSPLANTATION IN SITUS-INVERSUS WITH KARTAGENERS-SYNDROME

En bloc double lung transplantation with bilateral bronchial anastomos es was successfully performed in three patients with complete situs in versus and end-stage Kartagener's syndrome. Dextrocardia was not a tec hnical problem for institution of cardiopulmonary bypass, but a large azygos vein draining the systemic venous return was systematically pre served. The major technical difficulty was restoration of airway conti nuity, because patients with situs inversus have an inverse direction and length of the main stem bronchi. The right and left main bronchi o f the recipients were approached in the aortocaval sinus and transecte d approximately at 1.5 cm from the carina. The donor right main stem b ronchus was divided at its origin and the donor left main stem bronchu s was divided proximal to the upper lobe takeoff. The different bronch ial angulation was not an obstacle, and airway continuity was reestabl ished twice with an end-to-end anastomosis and once with a telescopic technique. Because of the midline position of the left atrium and pulm onary artery, the anastomoses with the respective recipient's structur es were made as in patients with situs solitus. One patient required a right lower lobectomy because the position of the right side of the h eart interfered with lobar expansion. One patient died of obliterative bronchiolitis 36 months after the operation. The remaining two are al ive and doing well after 48 and 6 months, respectively.