ABSTRACT: To discuss the operative indications and peri-operational management of single lung transplantation (SLT) and heart-lung transplantation (HLT) for patients suffering from Eisenmenger's syndrome (ES).
From September.2002 to March.2006, four ES patients, 1 males and 3 females, aged 16 approximately 19, 2 with atrial septal defect and 2 with ventricular septal defect, underwent single right lung transplantation, and one patients, male, aged 43, who suffered heart failure secondary to an interventional occlusion for atrial septal defect underwent cardiac repair and HLT.
Two patients, including the patient who received HLT and one, female, aged 15, who received SHT died of he died primary graft dysfunction on the 23rd day and 20th day post-operationally respectively. While the other 3 recipients kept a normal life for 5, 8, and 22 months respectively after operation with apparently decreased pulmonary artery pressure and improved cardiac-pulmonary functions.
Lung transplantation companies with cardiac repair is effective in the therapy of ES. Donor-recipient matching in size, proper removal and protection of the donor lung, and appropriate postoperational management are the key procedures for those patients to survive.
Zhonghua yi xue za zhi 06/2007; 87(17):1165-8.
ABSTRACT: To evaluate monitoring and cares in the intensive care unit (ICU) after lung transplantation.
From September 2002 to April 2005, there were 18 cases of lung transplant recipients, who had suffered from emphysema (9 cases), pulmonary fibrosis (5 cases), silicosis (1 cases), bronchiectasis (1 case), pulmonary vascular leiomyoma (1 case), ventricular septal defect and Eisenmenger's syndrome (1 case), respectively. Operative procedures included 9 cases with left lung transplantation, 5 right lung transplantation, 1 case right single lung transplantation and ventricular septal defect repair, and 3 cases bilateral lung transplantations. All the patients received mechanical ventilation, immunosuppressive agents, antibacterial prophylaxis, and prevention of reperfusion injury in the ICU after operation. Preoperatively, echocardiography (ECHO), artery blood gas,and oxygenation index (partial pressure of oxygen in artery/fraction of inspired oxygen, PaO(2)/FiO(2)) were observed.
The average weaning time from the ventilator was (7.39+/-4.89) days. The average ICU stay time was (9.72+/-8.32) days. The systolic pulmonary artery pressure (Ppa, syst) was monitored with Swan-Ganz catheterization 1 week post transplant, and it was found to have decreased significantly from (48.94+/-14.45) mm Hg (1 mm Hg=0.133 kPa) to (39.59+/-7.45) mm Hg (P<0.05). At the same time, oxygenation index was improved from (263.89+/-82.09) mm Hg to (345.56+/-92.18) mm Hg (P<0.05), partial pressure of carbon dioxide in artery (PaCO(2)) was decreased from (63.29+/-22.56) mm Hg to (38.37+/-9.19) mm Hg (P<0.05). In hospital mortality (HM) was 16.7% (3/18 cases), and an early death was due to severe infection on the 30 th postoperative day in 1 patient and acute rejection on the 15 th postoperative day in another patient, and the other patient died due to pulmonary vein embolism on the 36 th day. Fifteen patients recovered quickly and discharged from the hospital. One patient was followed up for 32 months.
Lung transplantation remains the only hope for many patients with end stage pulmonary disease. It is important that the lung transplant team possesses a working knowledge of the treatment of common complications, the time of these complications mostly likely to occur and how best to treat them when they do arise, to ensure long-term survival and success.
Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue 07/2006; 18(7):394-6.
Zhonghua yi xue za zhi 10/2004; 84(17):1416-7.
ABSTRACT: To evaluate operative technique, patient selection and perioperative management of single-lung transplantation for a patients with end-stage emphysema.
A 56-year-old patient with end-stage emphysema underwent left-lung transplantation on September 28, 2002. The surgical technique used was similar to that mentioned in the literature. The donor lung was perfused by LPD solution with a cold ischemic time of 260 minutes. Cardiopulmonary bypass was not performed.
The patient weaned from a ventilator at the 93th hour after operation. Immunosuppressants included cyclosporine, mycophenolate mofetil and corticosteroid. Acute rejection occurred on the ninth day after operation and was cured by bolus methylprednisolone given intravenously. Lung function was improved significantly and the patient was discharged from the hospital on the 47th day after operation.
Single-lung transplantation for patients with end-stage emphysema is effective for long-term improvement of pulmonary function.
Zhonghua wai ke za zhi [Chinese journal of surgery] 07/2003; 41(6):404-6.