Is it time for a paradigm shift: Should double-lung transplant be considered the treatment of choice for idiopathic pulmonary arterial hypertension and giant pulmonary aneurysm?

Autor: Pelenghi S; Division of Cardiac Surgery, IRCCS Fondazione Policlinico 'San Matteo', Pavia, Italy., Primiceri C; Division of Thoracic Surgery, IRCCS Fondazione Policlinico 'San Matteo', Pavia, Italy., Belliato M; Department of Cardiopulmonary Anesthesia, IRCCS Fondazione Policlinico 'San Matteo', Pavia, Italy., Ghio S; Department of Cardiology, IRCCS Fondazione Policlinico 'San Matteo', Pavia, Italy., Scelsi L; Department of Cardiology, IRCCS Fondazione Policlinico 'San Matteo', Pavia, Italy., Totaro P; Division of Cardiac Surgery, IRCCS Fondazione Policlinico 'San Matteo', Pavia, Italy.
Jazyk: angličtina
Zdroj: Journal of cardiac surgery [J Card Surg] 2021 Aug; Vol. 36 (8), pp. 2996-2999. Date of Electronic Publication: 2021 May 16.
DOI: 10.1111/jocs.15655
Abstrakt: Idiopathic pulmonary arterial hypertension is a rare condition, frequently complicated by pulmonary arteries' aneurysm. Aggressive medical therapy is often unsatisfactory and lung transplantation remains the only option. We report a unique case of severe idiopathic pulmonary arterial hypertension complicated by a giant pulmonary aneurism, massive pulmonary valve regurgitation, and right ventricle dysfunction. The patient was, as our first choice, listed for heart-lung transplantation and remained in emergency list for more than 7 months. Unfortunately, due to further clinical deterioration and the unavailability of a heart-lung bloc, plan B was mandatory. The patient underwent a combined procedure including: double lung transplant, pulmonary artery plasty, and sutureless pulmonary valve prosthesis with open deployment (first-in-man use in such scenario). Postoperative outcome was uneventful. Our thought is that double lung transplantation and conventional combined pulmonary artery/valve surgery should be considered as the first option avoiding excessive waiting times and potential further clinical deterioration.
(© 2021 Wiley Periodicals LLC.)
Databáze: MEDLINE
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