title: Pulmonary venous obstruction after lung transplantation. Diagnostic advantages of transesophageal echocardiography.
abstract: 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.
authors.affiliation: Department of Intensive Care Medicine, Hospital Universitario Marques de Valdecilla, Santander, Spain.
authors.forename: Camilo
authors.initials: C
authors.lastname: González-Fernández
authors.forename: Alejandro
authors.initials: A
authors.lastname: González-Castro
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Rodríguez-Borregán
authors.forename: Marta
authors.initials: M
authors.lastname: López-Sánchez
authors.forename: Borja
authors.initials: B
authors.lastname: Suberviola
authors.forename: Juan
authors.initials: J
authors.lastname: Francisco Nistal
authors.forename: Rafael
authors.initials: R
authors.lastname: Martín-Durán
mesh_terms: D000368:Aged; D003937:Diagnosis, Differential; D017548:Echocardiography, Transesophageal / Q000379:methods*; D017809:Fatal Outcome; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D011658:Pulmonary Fibrosis / Q000601:surgery*; D011668:Pulmonary Veno-Occlusive Disease / Q000000981:diagnostic imaging* / Q000209:etiology