Detection of circulatory disturbance after pulmonary vein division during a living donor lobectomy
- PDF / 1,165,727 Bytes
- 4 Pages / 595.276 x 790.866 pts Page_size
- 52 Downloads / 188 Views
CASE REPORT
Detection of circulatory disturbance after pulmonary vein division during a living donor lobectomy Yojiro Yutaka1 · Tatsuya Goto2 · Akihiro Ohsumi1 · Masatsugu Hamaji1 · Hiroshi Date1 Received: 21 August 2020 / Accepted: 10 November 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract Indocyanine green (ICG) is widely used during thoracic surgery to enhance visualization, allowing assessment of the intersegmental plane based on intrapulmonary blood flow (Travis et al. in Ann Thorac Surg 108(2):363–369, 2019; Seshiru et al. in Gen Thorac Cardiovasc Surg 66(2):81–90, 2018). Using ICG to detect blood flow disruption after lung resection, however, has not been addressed. We therefore report a case in which the left lingular pulmonary vein was incidentally divided during left lower lobectomy in a living-lung donor. Intraoperative ICG-enhanced near-infrared fluoroscopic imaging to assess intrapulmonary blood flow detected the problem. We thus avoided potential postoperative residual lung complications in this patient. Keywords Pulmonary vein · Postoperative complication · Indocyanine green
Introduction Identifying pulmonary vascular variations is essential during thoracic surgery because vascular anomalies can cause postoperative complications. Interrupting critical venous flow can lead to potentially fatal complications (e.g., lung edema, infarction, secondary infection). Indocyanine green (ICG) has been widely used to assess the intersegmental plane based on blood flow after pulmonary artery ligation during thoracoscopic segmentectomy [1]. There are no reports, however, that it has been used to assess postoperative blood flow to detect vascular abnormalities (e.g., dissection of pulmonary vascular variations) that could lead to complications. We report a case in which the left lingular pulmonary vein was incidentally divided during left lower Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11748-020-01552-7) contains supplementary material, which is available to authorized users. * Yojiro Yutaka [email protected]‑u.ac.jp 1
Department of Thoracic Surgery, Kyoto University Hospital, 54 Kawaharacho, Shogoin, Sakyo‑ku, Kyoto 606‑8507, Japan
Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
2
lobectomy in a living-lung donor. We successfully detected disrupted intrapulmonary blood flow using ICG-enhanced near-infrared fluoroscopy and removed additional lung tissue with no blood flow, thereby preventing potential postoperative complications.
Case The living-donor was a healthy 52-year-old man whose wife had a 6-year history of diffuse panbronchiolitis. At this admission, she underwent tracheostomy because of hypercapnia (PaCO2 114 mmHg) caused by repeated Pseudomonas aeruginosa infection and was placed on mechanical ventilator support. Semi-urgent, bilateral, living-donor lobar lung transplantation was performed using her sister’s right lower lobe and
Data Loading...
