Macchiarini P, Chapelier A, Vouhé P, Cerrina J, Ladurie F L, Parquin F, Brenot F, Simonneau G, Dartevelle P
Department of Thoracic and Vascular Surgery, Hôpital Marie-Lannelongue, Le Plessis Robinson, France.
J Thorac Cardiovasc Surg. 1994 Jul;108(1):86-91.
En bloc double lung transplantation with bilateral bronchial anastomoses was successfully performed in three patients with complete situs inversus and end-stage Kartagener's syndrome. Dextrocardia was not a technical problem for institution of cardiopulmonary bypass, but a large azygos vein draining the systemic venous return was systematically preserved. The major technical difficulty was restoration of airway continuity, because patients with situs inversus have an inverse direction and length of the main stem bronchi. The right and left main bronchi of the recipients were approached in the aortocaval sinus and transected approximately at 1.5 cm from the carina. The donor right main stem bronchus was divided at its origin and the donor left main stem bronchus was divided proximal to the upper lobe takeoff. The different bronchial angulation was not an obstacle, and airway continuity was reestablished twice with an end-to-end anastomosis and once with a telescopic technique. Because of the midline position of the left atrium and pulmonary artery, the anastomoses with the respective recipient's structures were made as in patients with situs solitus. One patient required a right lower lobectomy because the position of the right side of the heart interfered with lobar expansion. One patient died of obliterative bronchiolitis 36 months after the operation. The remaining two are alive and doing well after 48 and 6 months, respectively.
对三名完全性内脏反位并患有终末期卡塔格内综合征的患者成功实施了整块双肺移植及双侧支气管吻合术。右位心并非建立体外循环的技术难题，但系统性地保留了引流体循环静脉回流的粗大奇静脉。主要技术难题在于恢复气道连续性，因为内脏反位患者的主支气管方向和长度相反。在主动脉腔静脉窦处处理受者的左右主支气管，并在距隆突约1.5厘米处切断。供者右主支气管在其起始处切断，供者左主支气管在上叶起始部近端切断。不同的支气管角度并非障碍，通过端对端吻合术重建气道连续性两次，通过套入技术重建一次。由于左心房和肺动脉位于中线位置，与相应受者结构的吻合与正常位患者相同。一名患者因心脏右侧位置妨碍肺叶扩张而需要进行右下肺叶切除术。一名患者术后36个月死于闭塞性细支气管炎。其余两名患者分别在48个月和6个月后存活且情况良好。
