Prednisolone
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Prednisolone Anastomotic pulmonary artery stenosis: case report
A 59-year-old man developed anastomotic pulmonary artery stenosis (PAS) during treatment with prednisolone for interstitial pneumonitis. The man, who had chronic interstitial pneumonitis, presented with respiratory failure. He underwent unilateral left-side lung transplantation. Prior to the procedure, he had been receiving prolonged prednisolone 10 mg/day for over 2.5 years [route not stated]. During the procedure, his pulmonary artery was extremely fragile due to prolonged pre-operative steroid usage. On postoperative day (POD) 5, he was extubated. But, he was re-intubated on POD 8 due to hypercapnia and suspected ventilationperfusion (VQ) mismatch. On POD 5, a CT scan showed severe anastomotic PAS. Perfusion scintigraphy showed severe hypoperfusion of the transplanted lung with only 7% of total pulmonary blood flow. On POD 29, pulmonary artery angiogram showed severe left PAS. The man underwent balloon angioplasty. Subsequently, the diameter of the stenotic lesion improved; however, the stenosis had persisted with peak pressure gradient across PAS of 40mm Hg. Two days after angioplasty, he was extubated. He received antibacterial treatments for Pseudomonas aeruginosa bacteremia since POD 39. After 21 days of the balloon angioplasty, a followup scintigraphy showed improvement in blood flow in the transplanted lung; however, he still had respiratory symptoms with limitations in daily activities. Therefore, on POD 64, he underwent second balloon angioplasty. After the second angioplasty, the stenotic lesion diameter improved to 11.7mm. He was discharged on POD 92 with improvements in exercise tolerance and limitations in daily activities. On POD 169, a follow-up scintigraphy showed 58% in blood flow in the transplanted lung, and at one year after transplantation, a CT scan showed improved dimension of the stenotic lesion. His respiratory symptoms improved over time. Shiraga K, et al. Successful angioplasties using high pressure large balloons in a patient with severe anastomotic pulmonary artery stenosis soon after single-lung transplantation. Journal of Cardiology Cases 22: 22-25, No. 1, Jul 2020. Available from: URL: http://doi.org/10.1016/j.jccase.2020.03.008
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Reactions 12 Sep 2020 No. 1821
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