title: Postpneumonectomy Compression of the Mitral Annulus: Rare Vascular Complication in Sportive Patient.
abstract: Numerous postpneumonectomy complications exist. We present a rare clinical case of postpneumonectomy exertional dyspnea revealing compression of the mitral annulus by the descending aorta. The patient was 42-year-old former smoker with pulmonary emphysema. He has been operated on, in 2012 (i.e., right pneumonectomy). Before the surgery, the patient was a recreational runner. However, after some months, it was difficult for the patient to resume running. Cardiopulmonary exercise testing indicated moderate exercise intolerance with important oxygen desaturation. More interestingly, a decrease of low oxygen pulse was noticed from the first ventilatory threshold with no electrical modification on the electrocardiogram. This decrease was indicative of a decline in stroke volume. The thoracic scan revealed a right pneumonectomy pocket with a liquid abnormal content. Moreover, the mediastinum had shifted toward the pneumonectomy space and the left lung was distended and emphysematous. Echocardiography revealed a major change in the mediastinal anatomy. The mitral annulus was observed to be compressed by the rear wall of the descending aorta. The diagnosis of postpneumonectomy syndrome or platypnea-orthodeoxia syndrome was ruled out in this patient. Mitral annular compression by the descending aorta is rare complication, which must be researched in patients with postpneumonectomy exertional dyspnea.
authors.affiliation: Unité de Physiologie Respiratoire et Sportive, CHU de Rouen, 76031 Rouen, France.
authors.forename: David
authors.initials: D
authors.lastname: Debeaumont
authors.affiliation: Service de Pneumologie, CHU de Rouen, 76031 Rouen, France.
authors.forename: Susana
authors.initials: S
authors.lastname: Bota
authors.affiliation: Service de Chirurgie Vasculaire et Thoracique, CHU de Rouen, 76031 Rouen, France.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Baste
authors.affiliation: Service de Pneumologie, CHU de Rouen, 76031 Rouen, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Bellefleur
authors.affiliation: Service de Cardiologie, CHU de Rouen, 76031 Rouen, France.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Stepowski
authors.affiliation: Service de Radiologie, CHU de Rouen, 76031 Rouen, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Vincent
authors.affiliation: ADIR Association, Hôpital de Bois-Guillaume, 76230 Bois-Guillaume, France.
authors.forename: Tristan
authors.initials: T
authors.lastname: Bonnevie
authors.affiliation: ADIR Association, Hôpital de Bois-Guillaume, 76230 Bois-Guillaume, France.
authors.forename: Francis-Edouard
authors.initials: FE
authors.lastname: Gravier
authors.affiliation: Unité de Physiologie Respiratoire et Sportive, CHU de Rouen, 76031 Rouen, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Netchitailo
authors.affiliation: Unité de Physiologie Respiratoire et Sportive, CHU de Rouen, 76031 Rouen, France; ADIR Association, Hôpital de Bois-Guillaume, 76230 Bois-Guillaume, France; UPRES, EA 3830, GRHV, Faculté de Médecine, 76183 Rouen Cedex, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Tardif
authors.affiliation: Unité de Physiologie Respiratoire et Sportive, CHU de Rouen, 76031 Rouen, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Boutry
authors.affiliation: Service de Pneumologie, CHU de Rouen, 76031 Rouen, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Muir
authors.affiliation: CETAPS, EA 3832, UFR STAPS, Université de Rouen, 76821 Mont Saint Aignan, France.
authors.forename: Jérémy
authors.identifier: 0000-0001-6515-7736
authors.initials: J
authors.lastname: Coquart