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Pulmonary venous obstruction after lung transplantation. Diagnostic advantages of transesophageal echocardiography
Author(s) -
GonzálezFernández Camilo,
GonzálezCastro Alejandro,
RodríguezBorregán Juan Carlos,
LópezSánchez Marta,
Suberviola Borja,
Francisco Nistal Juan,
MartínDurán Rafael
Publication year - 2009
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/j.1399-0012.2009.01078.x
Subject(s) - medicine , pulmonary vein stenosis , thrombus , lung transplantation , stenosis , cardiology , radiology , transplantation , complication , pulmonary hypertension , thrombosis , pulmonary vein , angiography , pulmonary angiography , heart transplantation , lung , surgery , atrial fibrillation
Pulmonary venous vascular complications after lung transplantation are rare and a major cause of morbidity and mortality unless diagnosed and treated early. The epidemiological, diagnostic, and management characteristics of 33 patients (two of them in our hospital) with post‐transplant pulmonary vein obstruction published in the literature were reviewed. We consider of utmost importance to differentiate stenosis from thrombosis as the cause of the obstruction. The angiography, considered the gold standard for diagnosis, was replaced by transesophageal echocardiography (TEE) in 79% of the cases, but no echocardiographic diagnostic criteria were defined. A diameter of the pulmonary veins, with 2D/color TEE, <0.5 cm, peak systolic flow velocity (PSFV) >1 m/s, pulmonary vein‐left atrial pressure gradient (PVLAG) ≥10–12 mmHg, non‐permeable flow through the stenosis and the presence of thrombus at that level, must lead us to suspect this complication. Higher mortality rates were found in unilateral procedures and in women. We consider that TEE must be carried out as part of the intraoperative routine or within the first 24 h of the post‐operative period.