Living-Donor Lobar Lung Transplantation for Treatment of Idiopathic Pulmonary Arterial Hypertension With Severe Pulmonary Arterial Dilation Yuhei Yokoyama, MD,* Fengshi Chen, MD,* Kenji Minakata, MD, Tetsu Yamada, MD, Akihiro Aoyama, MD, Masaaki Sato, and Hiroshi Date, MD Departments of Thoracic Surgery and Cardiovascular Surgery, Kyoto University, Kyoto, Japan
Fig 2.
Fig 1.
A
20-year-old woman was diagnosed with idiopathic pulmonary arterial (PA) hypertension. Her PA pressure was 105/27 mm Hg despite high-dose epoprostenol infusion (193 ng $ kg 1 $ min 1). At age 27 years, she underwent living-donor lobar lung transplantation using her parents’ lower lobes. After bilateral living-donor lobar lung transplantation, the anterior wall of the dilated main PA was resected (Fig 1, arrows). The wall itself looked healthy, without internal thrombi. Then, the remaining PA wall was sutured directly (Fig 2). Now, 5 months postoperatively, her PA pressure is 32/11 mm Hg, and she feels well without oxygen supplementation. Chest computed tomography scans showed considerable improvement of the PA dilation (Fig 3: A, before transplantation and B, 5 months after transplantation). Pathology findings of resected pulmonary artery showed moderate to severe medial degeneration with intimal thickening, possibly considered as secondary to pulmonary hypertension. Pulmonary arterial dilation, also called PA aneurysm, is an extremely rare finding. A lung transplantation candidate *Drs Yokoyama and Chen contributed equally to this work. Address correspondence to Dr Date, Department of Thoracic Surgery, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan; e-mail: [email protected].
Ó 2014 by The Society of Thoracic Surgeons Published by Elsevier Inc
Fig 3.
with severe PA dilation requires repair or reconstruction of the recipient pulmonary artery. To date, there have been only a few case reports of lung transplantation in such patients, and all involved transplantation of cadaveric lungs [1, 2]. Cadaveric lung transplantation has the advantage of allowing PA reconstruction using the donor’s aorta, whereas living-donor lobar lung transplantation must be augmented with interposition of an artificial PA graft or a PA graft made from the recipient’s pericardium if direct resection and suturing is impossible [1].
References 1. Force SD, Lau CL, Moazami N, Trulock EP, Patterson GA. Bilateral lung transplantation and pulmonary artery reconstruction in a patient with chronic obstructive pulmonary disease and a giant pulmonary artery aneurysm. J Thorac Cardiovasc Surg 2003;126:864–6. 2. Shayan H, Sareyyupoglu B, Shigemura N, Thacker J, Bermudez C, Toyoda Y. Lung transplant, double valve repair, and pulmonary artery aneurysm resection. Ann Thorac Surg 2012;93:e3–5. Ann Thorac Surg 2014;97:e149 0003-4975/$36.00 http://dx.doi.org/10.1016/j.athoracsur.2014.02.071
Fig 2.
Fig 1.
A
20-year-old woman was diagnosed with idiopathic pulmonary arterial (PA) hypertension. Her PA pressure was 105/27 mm Hg despite high-dose epoprostenol infusion (193 ng $ kg 1 $ min 1). At age 27 years, she underwent living-donor lobar lung transplantation using her parents’ lower lobes. After bilateral living-donor lobar lung transplantation, the anterior wall of the dilated main PA was resected (Fig 1, arrows). The wall itself looked healthy, without internal thrombi. Then, the remaining PA wall was sutured directly (Fig 2). Now, 5 months postoperatively, her PA pressure is 32/11 mm Hg, and she feels well without oxygen supplementation. Chest computed tomography scans showed considerable improvement of the PA dilation (Fig 3: A, before transplantation and B, 5 months after transplantation). Pathology findings of resected pulmonary artery showed moderate to severe medial degeneration with intimal thickening, possibly considered as secondary to pulmonary hypertension. Pulmonary arterial dilation, also called PA aneurysm, is an extremely rare finding. A lung transplantation candidate *Drs Yokoyama and Chen contributed equally to this work. Address correspondence to Dr Date, Department of Thoracic Surgery, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan; e-mail: [email protected].
Ó 2014 by The Society of Thoracic Surgeons Published by Elsevier Inc
Fig 3.
with severe PA dilation requires repair or reconstruction of the recipient pulmonary artery. To date, there have been only a few case reports of lung transplantation in such patients, and all involved transplantation of cadaveric lungs [1, 2]. Cadaveric lung transplantation has the advantage of allowing PA reconstruction using the donor’s aorta, whereas living-donor lobar lung transplantation must be augmented with interposition of an artificial PA graft or a PA graft made from the recipient’s pericardium if direct resection and suturing is impossible [1].
References 1. Force SD, Lau CL, Moazami N, Trulock EP, Patterson GA. Bilateral lung transplantation and pulmonary artery reconstruction in a patient with chronic obstructive pulmonary disease and a giant pulmonary artery aneurysm. J Thorac Cardiovasc Surg 2003;126:864–6. 2. Shayan H, Sareyyupoglu B, Shigemura N, Thacker J, Bermudez C, Toyoda Y. Lung transplant, double valve repair, and pulmonary artery aneurysm resection. Ann Thorac Surg 2012;93:e3–5. Ann Thorac Surg 2014;97:e149 0003-4975/$36.00 http://dx.doi.org/10.1016/j.athoracsur.2014.02.071
![[Treatment of pulmonary arterial hypertension].](/assets/img/hold.png)
