Thoracoscopic native lung pneumonectomy after single lung transplant: initial experience with 2 cases

Abstract

Single lung transplants (SLTs) leave in place a diseased lung, a potential source of complications. Native lung pneumonectomy is occasionally indicated. We present 2 cases of native lung complications (NLCs) managed with video-assisted thoracoscopic surgery (VATS) pneumonectomy at our institution, a procedure never reported in this context before. Case 1 involves a 59-year old gentleman with refractory, invasive pulmonary aspergillosis of the native lung, 5 years after SLT for idiopathic pulmonary fibrosis. Case 2 involves a 66-year old gentleman with α-1 antitrypsin deficiency who developed severe haemoptysis and intraparenchymal haemorrhage in the native lung 12 years after SLT. A VATS pneumonectomy was performed in both cases because we believed it would facilitate wound healing and hasten recovery in immunosuppressed patients. Our short-term results align with this hypothesis. We conclude that VATS pneumonectomy is a feasible, adequate and safe procedure in this patient population; larger series are needed to draw definitive conclusions.

Thoracoscopic anatomic lung resections for cancer in patients with previous cardiac surgery

“…Conversely, in the remaining cases we did not find specific difficulties to perform VATS resections. In patient 1 and patient 3 undergoing cardiac transplantation, the pleura was not opened and in patient 4 undergoing mitral valve repair, even if it was opened, the adhesions of pleura remained limited and they did not increase significantly the surgical difficulties for a VATS resection (7,8).…”

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

“…Contralateral pneumonectomy after SLT has been reported in only 3 patients (ages 46, 56, and 66 years ( Table 3 ) [ 9 – 11 ]. Intractable air leak was incriminated in 1 case (17 days after SLT) [ 11 ] and progressive hyperinflation of the native lung in the other 2 patients (3 years and 12 years after SLT) [ 9 , 10 ].…”

“…Contralateral pneumonectomy after SLT has been reported in only 3 patients (ages 46, 56, and 66 years ( Table 3 ) [ 9 – 11 ]. Intractable air leak was incriminated in 1 case (17 days after SLT) [ 11 ] and progressive hyperinflation of the native lung in the other 2 patients (3 years and 12 years after SLT) [ 9 , 10 ]. In our patient, clinical improvement was achieved transiently after lung volume reduction and she underwent completion pneumonectomy 27 years after right SLT.…”

Native lung hyperinflation after single lung transplantation – case report and literature review

“…The most common complication in reviewed articles was hyperinflation (56% of the cases) 11,12,14,16 of the native lung but fungal infection (aspergillosis) was observed often as well (33%). [14][15][16] Symptoms were similar to the case we present: dyspnea, exercise intolerance and cough. Risk factors for hyperinflation are severe COPD and prolonged mechanical ventilation.…”