PURPOSE: Lung Transplantation is the sole therapeutic option for patients with end stage lung disease. Isolated case reports have described Pulmonary artery anastamotic stenosis post transplantation. Incidence, identification and management of this complication are varied. We report a series of 5 patients with this complication among our cohort of transplant recipients.
METHODS: Retrospective review of consecutive lung transplant recipients diagnosed with Pulmonary artery stenosis at the Methodist Hospital, Houston TX.
RESULTS: 4(1.7%) subjects were identified among 238 transplant recipients from 2005 to 2009.One subject underwent the procedure at a different center. Mean age was 64 years(48-76).One subject developed Hypoxic respiratory failure 4 hours post op. Mean duration to Pulmonary Angiogram was 15 months (1-11m). 3 had IPF and 2 ILD/CTD.3 L Single , 1 Right Single and 1 Bilateral Lung Transplantations. 80% (4/5) subjects presented with hypoxia and dyspnea. One subject presented with hemoptysis. ECHO showed no RV dysfunction in 80% (4/5)subjects. 2/3 L single transplant subjects had decreased perfusion to transplanted lungs. MRI/MRA was performed in one subject and was suggestive of PA Stenosis. All subjects underwent pulmonary angiogram for diagnosis. Significant drop in PA pressures across the Stenosis noted.4/5 subjects underwent stent placement with improvement in pulmonary artery pressures. Subject with immediate peri operative showed RV dysfunction with markedly elevated PA pressures on ECHO. PA gram revealed severe stenosis. She underwent surgical correction. Surgery was complicated by ventricular fibrillation on operative table and did not survive.
CONCLUSION: Pulmonary Artery Anastamotic Stenosis is a rare complication. Hypoxia and exercise intolerance are the usual presentation.
CLINICAL IMPLICATIONS: Once common etiologies for graft dysfunction are ruled out, anastamotic stenosis should be considered. Decreased perfusion to transplanted lung in single lung transplants is an important clue.ECHO is unreliable.Stenting is safe and tolerated. Immediate post operative presentation is a poor prognostic sign secondary to inability to perform stenting. MRI/MRA has a role in diagnostic work up and needs to be further studied.
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