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Chest wall reconstruction is a challenging area of thoracic surgery. The integrity of the chest wall is fundamental for correct respiratory dynamics and in protecting the organs contained in the thorax (1,2). The first chest wall reconstruction has been reported in the 1896 by Tensini

The use of extracorporeal membrane oxygenator instead of standard cardiopulmonary bypass during lung transplantation is debatable. Moreover, recently, the concept of prolonged postoperative extracorporeal membrane oxygenator (ECMO) support has been introduced in many transplant centers to prevent primary graft dysfunction (PGD) and improve early and long-term results.The objective of this study was to review the results of our extracorporeal life support strategy during and after bilateral sequential lung transplantation (BSLT) for pulmonary artery hypertension. We review retrospectively our experience in BSLT A total of 38 patients were identified. Nine patients were transplanted using cardiopulmonary bypass (CPB), in eight cases CPB was followed by a prolonged ECMO (pECMO) support, 14 patients were transplanted on central ECMO support, and seven patients were transplanted with central ECMO support followed by a pECMO assistance. The effects of different support strategies were evaluated, in particular in-hospital morbidity, mortality, incidence of PGD, and long-term follow-up. The use of CPB was associated with poor postoperative results and worse long-term survival compared with ECMO-supported patients. Predictive preoperative factors for the need of intraoperative CPB instead of ECMO were identified. The pECMO strategy had a favorable effect to mitigate postoperative morbidity and mortality, not only in intraoperative ECMO-supported patients, but even in CPB-supported cases. In our experience, ECMO may be considered as the first choice circulatory support for lung transplantation. Sometimes, in very complex cases, CBP is still necessary. The pECMO strategy is very effective to reduce incidence of PGD even in CPB-supported patients. K E Y W O R D S cardiopulmonary bypass, extracorporeal membrane oxygenation, extracorporeal support technique, lung transplantation, pulmonary hypertension 630 | DELL'AMORE Et AL. F I G U R E 1 Examples of clear indication for CPB instead of ECMO. A, extreme cardiomegaly. B, severe dilatation of the right and left pulmonary artery branches. C, severe aneurysm of the main pulmonary artery. D, over-systemic pulmonary artery hypertension (pulmonary artery pressure shown in yellow and systemic pressure shown in red) [Color figure can be viewed at wiley onlin elibr ary.com] F I G U R E 2 ECLS techniques. A, aorto-bicaval CPB cannulation. B, aorto-bicaval CPB cannulation with pulmonary artery vent (black arrow). C, central aorto-right atrium ECMO cannulation. D, prolonged ECMO setting with peripheral femoro-femoral cannulation with distal leg perfusion [Color figure can be viewed at wiley onlin elibr ary.com] How to cite this article: Dell'Amore A, Campisi A, Congiu S, et al. Extracorporeal life support during and after bilateral sequential lung transplantation in patients with pulmonary artery hypertension.

Peripheral vein catheterization is generally considered a harmless procedure. Venous catheter rupture associated with pulmonary embolism is an unlikely but potentially serious complication. We report a case of a peripheral venous catheter (PVC) fracture with pulmonary artery embolization in the left lower lobe treated successfully by a surgical approach. The positioning of a PVC is not always a harmless procedure. Every time there are difficulties in positioning or in removal of a catheter device, it should be carefully inspected to verify integrity. The advisability of removal of these small foreign bodies is debated; percutaneous retrieval is preferred, while surgery should be discussed case by case.

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Sialadenoma papilliferum is a benign salivary tumour which rarely occurs in the bronchial tree. Up to now, only four cases of pulmonary papillary sialadenoma have been reported in the literature. We discuss the case of a male patient with an accidental finding of a middle lobe nodule. The patient underwent a minimally invasive anatomical resection of the lobe to remove the lesion; the postoperative course was regular, and he was healthy at the last follow-up.