Four-year prospective study of pulmonary venous thrombosis after lung transplantation

The objective of this study was to prospectively assess pulmonary venous an astomosis by transesophageal echocardiography after lung transplantation. T hrombus formation at the pulmonary venous anastomotic site after lung trans plantation may have catastrophic consequences, including allograft failure and stroke. Eighty-seven consecutive adult lung transplant recipients under went transesophageal echocardiography within 48 hours after surgery. Thromb osis of a pulmonary vein was diagnosed In 13 (15%) of 87 patients in the ea rly postoperative period after lung transplantation. Mean thrombus width wa s 0.9 +/- 0.4 cm (range, 0.5 to 1.7 cm), with an average peak flow velocity at the site of obstruction of 127 +/- 23 cm/s (range, 90 to 150 cm/s). Fiv e patients with pulmonary vein thrombosis died in the perioperative period, yielding a go-day mortality rate of 38%. Larger thrombus size and greater acceleration of flow through a narrowed pulmonary vein correlated with poor clinical outcome. During each year of the study, the incidence of pulmonar y vein thrombosis declined progressively. Pulmonary vein thrombosis Is a po tentially ominous complication in the early postoperative period after lung transplantation. Transesophageal. echocardiography is a valuable tool for detecting abnormalities of the pulmonary venous; anastomosis. Thrombus size and flow velocity at the anastomotic site may guide prognosis and clinical management. Complications of the pulmonary venous anastomosis are in part technical in nature.