肺移植术后短期内发生的肺动脉狭窄：1例成功的球囊扩张和支架置入术

Pulmonary artery stenosis shortly after lung transplantation: successful balloon dilation and stent insertion in one case.

作者信息

Najafizadeh Katayoun, Daneshvar Abolghasem, Dezfouli Azizollah Abbasi, Kashani Babak Sharif, Ahmadi Zargham Hossein, Shadmehr Mohammad Behgam, Ghasemi Masoud, Kardavani Babak, Lankarani Maryam Moghani, Shafaghi Shadi

机构信息

Lung transplantation Research Center, National Research Institute of Tuberclosis and lung Disease, Shaheed Beheshti Medical Sciences University, Tehran, Iran.

出版信息

Ann Transplant. 2009 Jan-Mar;14(1):52-5.

PMID:19289997

Abstract

BACKGROUND

Pulmonary artery stenosis after lung transplantation is a rare complication. It usually requires surgical correction but even after that the outcome is not favorable.

CASE REPORT

The patient was a 53-years-old woman who was candidate for lung transplantation surgery due to pulmonary fibrosis. After 7 months on waiting list, with severe limitations in daily living activities, she received a single lung transplant in 2007. The surgery was performed without any complication. One day after surgery and after extubation, the patient needed oxygen supplementation through mask with reservoir bag. In bronchoscopy, black-and-white exudate and black membrane that blocked the main bronchus in the transplanted lung was observed. By bronchial lavage the membrane and exudate were successfully removed and patient received antibiotics for documented Aspergillus infection and methylprednisolone pulse therapy for evidences of graft rejection. Despite success in treatments of the mentioned complications, the condition of the patient deteriorated and she became totally dependent to supplemental oxygen. Oxygen consumption level had increase and pulmonary artery pressure was increasing gradually. With suspicion to pulmonary artery stenosis, bronchial CT-Scan with contrast was performed 13 days after transplantation surgery which showed a 50% stenosis. Trans-esophageal echocardiography also showed a stenosis with 40 mmHg gradient. 18 days after transplantation surgery, percutaneous balloon angioplasty was performed which was initially successful but re-stenosis occurred. Seven days later, another balloon angioplasty with stent insertion was performed. After the procedure, the gradient has been removed. Patient was discharged 30 days after transplantation. Follow-up after 10 months revealed no stenosis and the stent was working properly.

CONCLUSIONS

Stent angioplasty can be performed with no problem or complication if pulmonary artery stenosis is seen after lung transplantation.

摘要

背景

肺移植术后肺动脉狭窄是一种罕见的并发症。通常需要手术矫正，但即便如此，预后也不理想。

病例报告

该患者为一名53岁女性，因肺纤维化而成为肺移植手术的候选者。在等待名单上7个月后，由于日常生活活动严重受限，她于2007年接受了单肺移植。手术过程中未出现任何并发症。术后一天，拔管后，患者需要通过带储氧袋的面罩吸氧。在支气管镜检查中，观察到移植肺的主支气管被黑白渗出物和黑色膜状物阻塞。通过支气管灌洗，成功清除了膜状物和渗出物，患者因确诊曲霉菌感染接受了抗生素治疗，并因有移植物排斥的证据接受了甲泼尼龙冲击治疗。尽管上述并发症的治疗取得了成功，但患者的病情仍恶化，完全依赖吸氧。耗氧量增加，肺动脉压力逐渐升高。怀疑有肺动脉狭窄，在移植手术后13天进行了增强支气管CT扫描，结果显示有50%的狭窄。经食管超声心动图也显示有狭窄，压差为40 mmHg。移植手术后18天，进行了经皮球囊血管成形术，最初取得成功，但出现了再狭窄。7天后，再次进行了带支架植入的球囊血管成形术。术后，压差消失。患者在移植后30天出院。10个月后的随访显示无狭窄，支架功能正常。