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.