Postpneumonectomy syndrome - Recognition and management

Study objective: Postpneumonectomy, syndrome (PPS) Results from extreme shi ft and rotation of the mediastinum after pneumonectomy producing symptomati c proximal airway obstruction and air trapping. Herein, we review our exper ience in the treatment of PPS, (1)Patients: Five patients with PPS were treated at our institution between 1991 and 1997, Four patients had previous light pneumonectomy; one patient had left pneumonectomy. Dyspnea was the presenting symptom in all five pat ients. The time internal to onset of symptoms and to surgical correction ra nged from 6 months to 9 years (median: 6 months) and 9 months to 29 years ( median, 21 months) after pneumonectomy, respectively. Intervention: The clinical diagnosis of PPS was confirmed with chest radiog raph, tno-dimensional echocardiography, pulmonary function tests, CT scan, and awake fiberoptic bronchoscopy. Correction of PPS required reexploration of the pneumonectomy space followed by anterior pericardiorrhaphy and inse rtion of a saline solution-filled Silastic prosthesis (Dow Coming; Midland, MI) for the purpose of connecting the overshift of the mediastinum. There was no morbidity or mortality. Results: All patients had relief of dyspnea. Corrective repositioning of th e mediastinum was confirmed hy chest radiograph, CT scan, and awake fiberop tic bronchoscopy There was a mean increase in the cross-sectional diameter, as measured by CT scan, of the obstructed bronchus by 166.7% (range, 100 t o 300%) in foul patients. One patient had Ilo change in the measured diamet er. Postoperatively, the peak expiratory flow rate increased by a mean of 4 4.2% (range, 40 to 49%) in all five patients. Conclusion: The presence of PPS should be considered in all patients presen ting with progressive dyspnea after pneumonectomy. Repositioning of the med iastinum with a saline solution-filled prosthesis and anterior pericardiorr haphy is easily performed and provides immediate anti lasting symptomatic r elief.