Annals of Thoracic Surgery, 2015, Vol.99(3), p.1067(3)
To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.athoracsur.2014.04.143 Byline: Thomas Schweiger, Konrad Hoetzenecker, Andreas Bacher, Clemens Aigner, Walter Klepetko Abstract: Herein we report the case of a 60-year-old female patient who developed severe respiratory failure after right-sided pneumonectomy starting 2 hours after uneventful surgery. A computed tomographic scan revealed a completely congested left lower lobe. The underlying pathomechanism of this unique finding was a kinking effect of the left lower lobe vein over the descending aorta, caused by the shifting of the heart toward the right side. Even with immediate reintubation and aggressive ventilation it was impossible to stabilize the patient and therefore an extracorporal membrane oxygenation (ECMO) had to be implanted. The ECMO support and right-lateral and prone positioning of the patient markedly improved oxygenation. After a stabilization period of 2 days the ECMO could be removed and the patient was extubated on the ninth postoperative day. To the best of our knowledge, this is the first reported case of a unilobar edema caused by a transiently impaired venous drainage after pneumonectomy. The combination of immediate ECMO support together with right-lateral and prone positioning resulted in restoration and stabilization of the patient's cardiorespiratory function. Author Affiliation: (a) Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria (b) Christian Doppler Laboratory for Cardiac and Thoracic Diagnosis and Regeneration, Medical University of Vienna, Vienna, Austria (c) Department of Anaesthesia, General Intensive Care and Pain Management, Medical University of Vienna, Vienna, Austria Article History: Accepted 1 April 2014
Pneumonectomy ; Heart
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