title: Intraoperative transesophageal echocardiographic assessment of vascular anastomoses in lung transplantation. A report on 18 cases.
abstract: BACKGROUND
  In patients after lung transplantation, dysfunction of pulmonary venous and artery anastomoses leading to reoperation is described.
  
  
  RESULTS
  Pulmonary artery and vein anastomoses were evaluated intraoperatively by monoplane transesophageal echocardiography (TEE) in 18 patients undergoing lung transplantation (nine right, five left single lung transplantations, and four bilateral transplantations). All 13 right pulmonary artery anastomoses and all 22 pulmonary vein anastomoses could be visualized by TEE. None of the nine left pulmonary anastomoses could be visualized. Of the 13 right pulmonary anastomoses, 12 were considered normal, their diameter ranging from 1 to 1.7 cm (mean, 1.26 +/- 0.24 cm). A moderate stenosis of one pulmonary artery anastomosis was identified but did not require reoperation. Of the 22 pulmonary vein anastomoses, 16 were considered normal, their diameter being > 0.5 cm and the peak systolic flow velocity < or = 1 m/s at the location of the anastomoses. In five cases, the anastomoses were not considered normal, but reoperation was not indicated. In one case, a severe stenosis of pulmonary vein associated with graft dysfunction led to an early reoperation.
  
  
  CONCLUSIONS
  Intraoperative TEE during lung transplantation contributes to the immediate evaluation of pulmonary vein and right pulmonary artery anastomoses and allows immediate surgical correction. Further investigations are necessary to establish threshold values requiring reoperation.
authors.affiliation: Service d'Anesthésie, Hôpital Foch, Suresnes, France.
authors.forename: M
authors.initials: M
authors.lastname: Michel-Cherqui
authors.forename: A
authors.initials: A
authors.lastname: Brusset
authors.forename: N
authors.initials: N
authors.lastname: Liu
authors.forename: L
authors.initials: L
authors.lastname: Raffin
authors.forename: S
authors.initials: S
authors.lastname: Schlumberger
authors.forename: A
authors.initials: A
authors.lastname: Ceddaha
authors.forename: M
authors.initials: M
authors.lastname: Fischler
mesh_terms: D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical; D001783:Blood Flow Velocity; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000601:surgery; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007430:Intraoperative Care; D016040:Lung Transplantation / Q000009:adverse effects / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D011667:Pulmonary Veins / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D012039:Regional Blood Flow; D012086:Reoperation; D015996:Survival Rate; D013599:Systole; D018615:Ultrasonography, Doppler, Color; D018617:Ultrasonography, Doppler, Pulsed; D014652:Vascular Diseases / Q000000981:diagnostic imaging / Q000601:surgery; D014654:Vascular Patency