Case report
Pulmonary Vein Thrombosis, Lung Transplantation, and Intraoperative Transesophageal Echocardiography

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Case 1

A 59-year-old man was undergoing bilateral sequential lung transplantation for end-stage lung disease secondary to chronic obstructive pulmonary disease and bronchiectasis. His past history was notable for repair of an abdominal aortic aneurysm 18 years earlier and a forced expiratory volume in 1 second (FEV1) that was 33% of predicted. He had moderate pulmonary hypertension, an angiographically documented 50% lesion of the circumflex coronary artery, and was treated with oral aspirin, 150

Case 2

A 36-year-old man was undergoing bilateral sequential lung transplantation for end-stage lung disease secondary to cystic fibrosis. He had an FEV1 that was 20% of predicted and no other comorbidities including no history of thromboembolic disease. Invasive monitoring was the same as for the first case, and a balanced anesthetic technique was employed using fentanyl, rocuronium, and a propofol infusion. A norepinephrine infusion was continued throughout the case (0.1 μg/kg/min) to maintain a

Case 3

A 32-year-old man was undergoing bilateral sequential lung transplantation for end-stage lung disease secondary to cystic fibrosis. His FEV1 was 20% of predicted, and he had documented gastroesophageal reflux disease and exocrine pancreatic insufficiency. He had no history of thromboembolic disease. Invasive monitoring and the anesthesia technique were the same as for the previous 2 cases. Extensive bilateral adhesions made the lung dissection difficult, and at the request of the surgeons,

Discussion

Three prospective studies4, 5, 6 have attempted to define the incidence of pulmonary venous anastomotic thrombosis after lung transplantation by performing TEE in patients in the early postoperative period. Although previously considered an uncommon problem, PVT was found to be present in 9% to 24% of patients in these small case series. The authors have used intraoperative TEE routinely for lung transplantation for the last 3 years and in that time have performed 81 lung transplants and

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