Wu Weidong, Huang Lin, Ye Bing, Zheng Bin, Chen Chun, Chen Jingyu
Department of Thoracic Surgery and Lung Transplantation Center, Fujian Medical University Affiliated Union Hospital, Fuzhou, China.
Key Laboratory of Cardiothoracic Surgery, Fujian Medical University, Fuzhou, China.
Heliyon. 2024 Apr 16;10(9):e29805. doi: 10.1016/j.heliyon.2024.e29805. eCollection 2024 May 15.
Abnormalities in pulmonary vasculature or technical issues during lung procurement can lead to an insufficient left atrial (LA) cuff in donors. However, surgeons frequently need to reconfigure these less-than-ideal lungs for transplantation. This case report introduces a novel technique for such reconstruction. The patient was a 35-year-old male diagnosed with pneumoconiosis for over a year. Due to progressive worsening dyspnoea leading to respiratory failure on multiple occasions, he was deemed a candidate for lung transplantation. While obtaining the donor's lung, an inadvertent short cut of the LA cuff around the left inferior pulmonary vein orifice resulted in the residual vein retracting into the pulmonary hilum. To overcome this, we employed the aortic arch for reconstruction, enabling the successful completion of the lung transplantation. On post-transplantation day 2, extracorporeal membrane oxygenation was no longer required. Mechanical ventilation ceased after 13 days, with the subsequent removal of a tracheostomy. The patient spent 35 days in the intensive care unit and 58 days in the hospital. Post-transplantation complications included primary graft dysfunction, acute kidney failure, pneumothorax in the transplanted lung, the clots in the inferior vena cava, and pneumonia. Remarkably, over a year of follow-up (19 months after lung transplantation), the patient reported no adverse events and had successfully returned to work. In this case, the aortic arch is an alternative for reconstructing an insufficient LA cuff.
肺血管异常或肺获取过程中的技术问题可导致供体左心房（LA）袖带不足。然而，外科医生经常需要对这些不太理想的肺进行重新配置以用于移植。本病例报告介绍了一种用于此类重建的新技术。该患者为一名35岁男性，诊断为尘肺病已一年多。由于进行性加重的呼吸困难多次导致呼吸衰竭，他被认为是肺移植的候选人。在获取供体肺时，左下肺静脉口周围的LA袖带意外被短切，导致残留静脉回缩至肺门。为克服这一问题，我们采用主动脉弓进行重建，从而成功完成了肺移植。移植后第2天，不再需要体外膜肺氧合。13天后停止机械通气，随后拔除气管造口管。患者在重症监护病房住院35天，在医院住院58天。移植后并发症包括原发性移植功能障碍、急性肾衰竭、移植肺气胸、下腔静脉血栓形成和肺炎。值得注意的是，经过一年多的随访（肺移植后19个月），患者报告无不良事件，并已成功重返工作岗位。在本病例中，主动脉弓是重建不足的LA袖带的一种替代方法。
