Contralateral Pneumonectomy 27 Years After Right Single-Lung Transplantation for Emphysema: A Case Report

Article Article scientifique Rapport de cas Contralateral Pneumonectomy 27 Years After Right Single-Lung Transplantation for Emphysema: A Case Report eng 2022-08-02 2022-08-02 author Boulos Georges 985843 author Schorer Raoul 0000-0001-7848-7021 594203 author Karenovics Wolfram 501317 author Triponez Frédéric 0000-0001-7808-496X 28673 author Bedat Benoît 565412 author Licker Marc 133428 e936748 10.12659/AJCR.936748 35917278 1941-5923 PMC9358625 https://amjcaserep.com/abstract/full/idArt/936748 BACKGROUND: Following single-lung transplantation, native lung inflation can progressively develop in patients with emphysema. CASE REPORT: A 74-year-old female patient presented with worsening dyspnea during daily activities. She underwent a right single-lung transplantation for emphysema 27 years ago. Despite recurrent episodes of acute rejection of the grafted lung, the patient had satisfactory recovery of physical fitness during that period and did not report any serious complications or respiratory symptoms. Her recent dyspnea was due to hyperinflation of the native emphysematous lung with mediastinal shift, reduction of venous blood return, and compression of the grafted lung. Although surgical lung volume reduction had resulted in temporary functional improvement 2 years ago, a completion contralateral pneumonectomy was deemed necessary to allow re-expansion of the grafted lung. After anesthesia induction and placement of a double-lumen tube, selective ventilation of the left emphysematous native lung confirmed the absence of gas exchange based on near-zero end-expiratory carbon dioxide fraction. During selective ventilation of the grafted lung, satisfactory gas exchange was achieved and pneumonectomy proceeded uneventfully under minimally-invasive thoracotomy. Immediately after anesthesia emergence and tracheal extubation, the patient experienced respiratory improvement. Continuous thoracic epidural blockade allowed pain-free mobilization and respiratory therapy to facilitate re-expansion of the grafted lung. CONCLUSIONS: After single-lung transplantation in COPD patients, native lung hyperinflation is a well-described rare complication. Lung volume reduction including pneumonectomy can be considered a valuable treatment option. Aged Dyspnea Emphysema Female Humans Lung Transplantation Pneumonectomy / methods Postoperative Complications / surgery Pulmonary Emphysema / surgery Dewey 617 57 Département de chirurgie 222 63 Département d'anesthésiologie, pharmacologie, soins intensifs et urgences 229 false 902 Cancer du poumon et mésothéliome pleural malin 944 218 Dysfonctions cardio-pulmonaires et cérébrales 278 The American journal of case reports 23 36ca36cf-4ab7-438c-9484-f08a66022ed8 Article (Published version) Public 936748.pdf 2560342 application/pdf CC BY-NC-ND-4.0 openAccess Faculté de médecine / Section de médecine clinique / Département de chirurgie Faculté de médecine / Section de médecine clinique / Département d'anesthésiologie, pharmacologie, soins intensifs et urgences

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Contralateral Pneumonectomy 27 Years After Right Single-Lung Transplantation for Emphysema: A Case Report	The American journal of case reports			2022	162	241

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Boulos, Georges