title: Blood stasis may cause thrombosis in the left superior pulmonary vein stump after left upper lobectomy.
abstract: BACKGROUND
  We previously reported that arterial infarction of vital organs after lobectomy might occur only after left upper lobectomy and be caused by thrombosis in the left superior pulmonary vein stump. We hypothesized that changes in blood flow, such as blood stasis and disturbed stagnant flow, in the left superior pulmonary vein stump cause thrombosis, and this was evaluated by intraoperative ultrasonography.
  
  
  METHODS
  From July 2013 to April 2014, 24 patients underwent lobectomy in the Steel Memorial Muroran Hospital. During the procedure, an ultrasound probe was placed at the pulmonary vein stump and the velocity in the stump was recorded with pulse Doppler mode. The peak velocity and the presence of spontaneous echo contrast in the stump were evaluated. After the operation, the patients underwent contrast-enhanced CT within 3 months.
  
  
  RESULTS
  The operative procedures were seven left upper lobectomies, four left lower lobectomies, seven right upper lobectomies, and six right lower lobectomies. Blood flow was significantly slower in the left superior pulmonary vein stump than in the right pulmonary vein stumps. However, that was not significantly slower than that in the left inferior pulmonary vein stump. Spontaneous echo contrast in the pulmonary vein stump was seen in three patients who underwent left upper lobectomy. Of the three patients with spontaneous echo contrast, two patients developed thrombosis in the left superior vein stump within 3 months after the operation. There was no patient who developed arterial infarction.
  
  
  CONCLUSIONS
  In patients who underwent left upper lobectomy, intraoperative ultrasonography to evaluate blood flow and the presence of spontaneous echo contrast in the left superior pulmonary vein stump may be useful to predict thrombosis that may cause arterial infarction.
authors.forename: Kazuto
authors.initials: K
authors.lastname: Ohtaka
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Satoko
authors.initials: S
authors.lastname: Uemura
authors.forename: Yasuhito
authors.initials: Y
authors.lastname: Shoji
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hayama
authors.forename: Tatsunosuke
authors.initials: T
authors.lastname: Ichimura
authors.forename: Naoto
authors.initials: N
authors.lastname: Senmaru
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Hida
authors.forename: Kichizo
authors.initials: K
authors.lastname: Kaga
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Matsui
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects* / Q000379:methods; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000601:surgery*; D012039:Regional Blood Flow; D012189:Retrospective Studies; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology*