Incidence of pulmonary vein complications after lung transplantation: a prospective transesophageal echocardiographic study.
OBJECTIVE
This study attempted to document the incidence of pulmonary vein complications and their potential relation to clinical outcome in patients after lung transplantation.


BACKGROUND
Several case reports have documented the presence of pulmonary venous thrombosis causing graft failure in patients after lung transplantation. Because the presentation of these complications mimics that of other postoperative problems, the true incidence of pulmonary vein abnormalities remains unclear. Transesophageal echocardiography is ideally suited to examine the pulmonary veins in the postoperative setting.


METHODS
Twenty-one consecutive patients undergoing lung transplantation at our institution underwent transesophageal echocardiography within 32 days of transplantation (mean [+/- SD] 6.5 +/- 7.8 days). Special attention was placed on visualizing the pulmonary veins.


RESULTS
Six (29%) of the 21 patients were noted to have abnormalities of the pulmonary veins in the vicinity of the anastomotic site. After follow-up of 30 days, 4 of these patients (67%) had significant cardiovascular morbidity, and 2 died, compared with 1 (7%) of 15 patients with normal pulmonary veins (p = 0.03). The degree of obstruction of the pulmonary vein appeared to correlate with short-term outcome.


CONCLUSIONS
Abnormalities of the pulmonary veins are common after lung transplantation and are easily identified by transesophageal echocardiography. Occlusive thrombi appear to be detrimental to short-term outcome.
Leibowitz
D W
DW
Division of Cardiology, Columbia University, New York, New York.
Smith
C R
CR
Michler
R E
RE
Ginsburg
M
M
Schulman
L L
LL
McGregor
C C
CC
Li Mandri
G
G
Weslow
R G
RG
Di Tullio
M R
MR
Homma
S
S
D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011667:Pulmonary Veins; D013927:Thrombosis / Q000000981:diagnostic imaging* / Q000453:epidemiology