PURPOSE: Pulmonary arterial anastamotic stenoses in a post transplant patient is uncommon. We studied the incidence of pulmonary stenosis and their impact on outcome at our center.
METHODS: We retrospectively reviewed charts of patients who underwent lung transplant from January 2006 to March 2008. The following data were collected- demographics, type of transplant, cardio pulmonary bypass time, ischemic time and pulmonary physiological data.
RESULTS: A total of 85 patients underwent lung transplant . Twenty one underwent single and 64 double lung transplant. Two patients in this cohort developed pulmonary aterial stenoses. The clinical course of the first patient was marked by primary graft dysfunction and thereafter gradual improvement in his pulmonary function. Though he subjectively felt better, his 6 minute walk consistently demonstrated significant oxygen desaturation requiring 4 liters of oxygen to complete the walk . His ventilation-perfusion (V/Q) scan demonstrated a fixed left upper lobe perfusion defect.Pulmonary angiogram(PA) demonstrated left pulmonary artery stenosis with proximal mild pulmonary artery hypertension and a down stream gradient. An endovascular stent was placed with resolution of gradient and improved 6 minute walk without desauration. The second patient, in contrast to the first, was significantly symptomatic in the immediate post transplant period with severe exertional oxygen desaturation. His radiological imaging and lung biopsies were normal in this time period. V/Q scan demonstrated diminished perfusion to the transplanted lung (20% vs. 80%). PA demonstrated 90% stenosis of his pulmonary artery at the level of the anastamosis. An endovascular stent was placed with complete resolution of his symptoms.
CONCLUSION: Pulmonary artery stenosis is an uncommon differential for graft dysfunction in Lung transplant patients, but unique in being amenable to non surgical therapy with dramatic results.
CLINICAL IMPLICATIONS: High index of clinical suspicion is needed to diagnose this entity. Clinical presentation can be early or late and Endovascular intervention is the mainstay of treatment.
DISCLOSURE: S. Jyothula, No Financial Disclosure Information; No Product/Research Disclosure Information