Evaluating the Diagnostic Utility of Coronary CT Angiography in Elderly Population

Abstract

Background: Pulmonary vein stenosis or thrombosis (PVST) following lung transplantation is a rare but serious complication that may lead to graft failure. Diagnosis is challenging, as its radiographical features mimic infection or other causes of pulmonary oedema. Transoesophageal echocardiography is often requested to evaluate anastamoses to exclude PVST, though reference ranges for normal Doppler flow in this setting are not widely known, and pulmonary vein velocities are often elevated in the immediate post-transplant period. Aims: To determine pulmonary vein Doppler flow ranges in patients not suspected to have PVST in the post transplant period. Methods: All lung transplants performed in the last six years were identified from a database. The pulmonary vein Doppler velocities were recorded from the left and the right pulmonary vein 'buttons'. Clinical details were reviewed to determine if a clinical suspicion of PVS was present. Velocities recorded on the first transthoracic echocardiogram (TTE) or transoesophageal echocardiogram (TOE) post transplant were recorded. Results: There were a total of 108 patients (five single lung transplants, 103 double), with baseline characteristics age 44 ± 13years, 50/108 female. Velocities were able to be measured in 43 patients (17 TOE, 26TTE), a median of 11 days post transplant. Two patients were diagnosed with PVS (systolic/diastolic velocities 120/180 cm/s and 120/220 cm/s) and these values were excluded from calculations. Right pulmonary veins Left pulmonary veins Systolic 69 ± 34 cm/s (range 20-200) 79 ± 37 cm/s (20-161) Diastolic 85 ± 34 cm/s (37-190) 95 ± 37 ± cm/s (40-177) Conclusions: Pulmonary vein velocities are mildly elevated in patients following lung transplantation, in the absence of PVST.