Successful use of mediastinal repositioning employing PTFE sheet for right-sided post-pneumonectomy syndrome.
Post-pneumonectomy syndrome (PPS) is a rare late complication of pneumonectomy, and diverse treatments have been employed. We herein present a useful technique for right-sided PPS. The patient was a 53-year-old female who underwent a right pneumonectomy for locally advanced squamous cell lung cancer (pT2N2M0). Mild dyspnea and stridor developed and progressed 1 year after surgery. A chest roentgenogram and computed tomography (CT) scan showed a right-sided mediastinal shift. Under local anesthesia, a chest tube with a balloon was inserted into the right thoracic cavity, and the balloon was inflated with air. Dyspnea and stridor improved and disappeared as the balloon expanded. Then, mediastinal fixation was performed under general anesthesia. Mediastinal fixation involved a PTFE (polytetrafluoroethylene) sheet which was sewn on the sternum and costal cartilage anteriorly, on the vertebra posteriorly, and covered the azygos vein level superiorly and two thirds of the pericardium inferiorly using nonabsorbable sutures. A post-operative chest roentgenogram and CT scan showed improvement of the right-sided mediastinal shift. The post-operative course was uneventful, and dyspnea and stridor were improved and became stable. In conclusion, the presented method is a useful procedure for right-sided PPS.
Kitsuki Central Hospital, Oita, Japan.
Masao
M
Chujo
Kentaro
K
Anami
Katsunobu
K
Kawahara
D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D004867:Equipment Design; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008477:Mediastinal Diseases / Q000175:diagnosis / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000009:adverse effects*; D011138:Polytetrafluoroethylene; D012086:Reoperation; D013523:Surgical Equipment; D013577:Syndrome; D013908:Thoracotomy / Q000295:instrumentation*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D011138:Polytetrafluoroethylene