M. Michelcherqui et al., INTRAOPERATIVE TRANSESOPHAGEAL ECHOCARDIOGRAPHIC ASSESSMENT OF VASCULAR ANASTOMOSES IN LUNG TRANSPLANTATION - A REPORT ON 18 CASES, Chest, 111(5), 1997, pp. 1229-1235
In patients after lung transplantation, dysfunction of pulmonary venou
s and artery anastomoses leading to reoperation is described. Methods
and results: Pulmonary artery and vein anastomoses were evaluated intr
aoperatively by monoplane transesophageal echocardiography (TEE) in 18
patients undergoing lung transplantation (nine right, five left singl
e lung transplantations, and four bilateral transplantations). All 13
right pulmonary artery anastomoses and all 22 pulmonary vein anastomos
es could be visualized by TEE. None of the nine left pulmonary anastom
oses could be visualized, Of the 13 right pulmonary anastomoses, 12 we
re considered normal, their diameter ranging from 1 to 1.7 cm (mean, 1
.26+/-0.24 cm). A moderate stenosis of one pulmonary artery anastomosi
s was identified but did not require reoperation, Of the 22 pulmonary
vein anastomoses, 16 were considered normal, their diameter being >0.5
cm and the peak systolic flow velocity less than or equal to 1 m/s at
the location of the anastomoses, In five cases, the anastomoses were
not considered normal, but I reoperation was not indicated. In one cas
e, a severe stenosis of pulmonary vein associated with graft dysfuncti
on led to an early reoperation. Conclusion: Intraoperative TEE during
lung transplantation contributes to the immediate evaluation of pulmon
ary vein and light pulmonary artery anastomoses and allows immediate s
urgical correction. Further investigations are necessary to establish
threshold values requiring reoperation.