Anastomotic pitfalls in lung transplantation

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Presentation transcript:

Anastomotic pitfalls in lung transplantation Bartley P. Griffith, MD, Mitchell J. Magee, MD (by invitation), Ivan F. Gonzalez, MD (by invitation), Remi Houel, MD (by invitation), John M. Armitage, MD (by invitation), Robert L. Hardesty, MD, Brack G. Hattler, MD (by invitation), Peter F. Ferson, MD (by invitation), Rodney J. Landreneau, MD (by invitation), Robert J. Keenan, MD (by invitation) The Journal of Thoracic and Cardiovascular Surgery Volume 107, Issue 3, Pages 743-754 (March 1994) DOI: 10.5555/uri:pii:S0022522394703302 Copyright © 1994 Mosby, Inc. Terms and Conditions

Fig. 1 Right donor lung is prepared for implantation by division of airway, artery, and venous cuff close to their respective branch points. The Journal of Thoracic and Cardiovascular Surgery 1994 107, 743-754DOI: (10.5555/uri:pii:S0022522394703302) Copyright © 1994 Mosby, Inc. Terms and Conditions

Fig. 2 Modified horizontal mattress suture technique that avoids potential for obstructing flange of invaginated cartilage. The Journal of Thoracic and Cardiovascular Surgery 1994 107, 743-754DOI: (10.5555/uri:pii:S0022522394703302) Copyright © 1994 Mosby, Inc. Terms and Conditions

Fig. 3 Pulmonary arterial anastomosis distorted as result of excessive lengths of donor and recipient right pulmonary artery cuff. The Journal of Thoracic and Cardiovascular Surgery 1994 107, 743-754DOI: (10.5555/uri:pii:S0022522394703302) Copyright © 1994 Mosby, Inc. Terms and Conditions

Fig. 4 Right pulmonary angiogram showing narrowed origin of branch to right upper lobe. The Journal of Thoracic and Cardiovascular Surgery 1994 107, 743-754DOI: (10.5555/uri:pii:S0022522394703302) Copyright © 1994 Mosby, Inc. Terms and Conditions

Fig. 5 Stenotic left pulmonary artery anastomosis. The Journal of Thoracic and Cardiovascular Surgery 1994 107, 743-754DOI: (10.5555/uri:pii:S0022522394703302) Copyright © 1994 Mosby, Inc. Terms and Conditions

Fig. 6 Improved perfusion of left lung allograft after revision of stenotic anastomosis. PRE, Before revision; POST, after revision; L, left; R, right. The Journal of Thoracic and Cardiovascular Surgery 1994 107, 743-754DOI: (10.5555/uri:pii:S0022522394703302) Copyright © 1994 Mosby, Inc. Terms and Conditions

Fig. 7 A, Chest radiograph demonstrating unilateral pulmonary edema after left lung transplantation. B, Chest radiograph 3 months after revision of obstructing pulmonary venous atrial cuff. The Journal of Thoracic and Cardiovascular Surgery 1994 107, 743-754DOI: (10.5555/uri:pii:S0022522394703302) Copyright © 1994 Mosby, Inc. Terms and Conditions

Fig. 8 Left lung transplant with redundant donor pulmonary venous atrial cuff that obstructed venous flow from allograft. The Journal of Thoracic and Cardiovascular Surgery 1994 107, 743-754DOI: (10.5555/uri:pii:S0022522394703302) Copyright © 1994 Mosby, Inc. Terms and Conditions

Fig. 9 A, Transesophageal echogram of right-sided pulmonary venous anastomosis. Large thrombus (T) along atrial cuff and obstructed flow from right pulmonary vein (RPV) are noted.LA, Left atrium. B, Doppler wave form from transesophageal study in Fig. 7,A. Near uniform wave suggests abnormal obstructed flow from right-sided vein. The Journal of Thoracic and Cardiovascular Surgery 1994 107, 743-754DOI: (10.5555/uri:pii:S0022522394703302) Copyright © 1994 Mosby, Inc. Terms and Conditions