Chronic thromboembolic pulmonary hypertension (CTEPH) is one of the indications for lung transplantation. When patients with CTEPH undergo transplantation, massive bleeding can occur because of severe pleural adhesions and collateral vessels that develop from the thoracic wall to the lungs. However, there has been no previous case report that has discussed the bleeding risk in detail. We report the case of a patient having CTEPH who underwent bilateral lung transplantation with massive blood loss (11,730 mL) in the first operation and required repeat operations for hemostasis. The patient underwent left upper lobectomy because compromised blood flew to the left upper lobe. He recovered from the operations by postoperative day 9; however, he died from pyothorax from an intractable air leak 56 days after transplantation.
References
[1]
Task Force for Diagnosis and Treatment of Pulmonary Hypertension of European Society of Cardiology (ESC), European Respiratory Society (ERS); International Society of Heart and Lung Transplantation (ISHLT), et al., “Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension,” European Respiratory Journal, Vol. 34, No. 6, 2009, pp. 1219-1263.
http://dx.doi.org/10.1183/09031936.00139009
[2]
P. Dartevelle, E. Fadel, S. Mussot, et al., “Chronic Thromboembolic Pulmonary Hypertension,” European Respiratory Journal, Vol. 23, No. 4, 2004, pp. 637-648.
http://dx.doi.org/10.1183/09031936.04.00079704
[3]
A. Chapelier, P. Vouhé, P. Macchiarini, et al., “Comparative Outcome of Heart-Lung and Lung Transplantation for Pulmonary Hypertension,” The Journal of Thoracic and Cardiovascular Surgery, Vol. 106, No. 2, 1993, pp. 299-307.
[4]
E. Fadel, G. M. Mazmanian, B. Baudet, et al., “Endothelial Nitric Oxide Synthase Function in Pig Lung after Chronic Pulmonary Artery Obstruction,” American Journal of Respiratory and Critical Care Medicine, Vol. 162, No. 4, 2000, pp. 1429-1434.
http://dx.doi.org/10.1164/ajrccm.162.4.2001010
[5]
D. M. Smadja, L. Mauge, O. Sanchez, et al., “Distinct patterns of Circulating Endothelial Cells in Pulmonary Hypertension,” European Respiratory Journal, Vol. 36, No. 6, 2010, pp. 1284-1293.
http://dx.doi.org/10.1183/09031936.00130809
[6]
F. Ius, C. Kuehn, I. Tudorache, et al., “Lung Transplantation on Cardiopulmonary Support: Venoarterial Extracorporeal Membrane Oxygenation Outperformed Cardiopulmonary Bypass,” The Journal of Thoracic and Cardiovascular Surgery, Vol. 144, No. 6, 2012, pp. 1510-1516. http://dx.doi.org/10.1016/j.jtcvs.2012.07.095
[7]
K. Kotani, S. Ichiba, M. Andou, et al., “Extracorporeal Membrane Oxygenation with Nafamostat Mesilate as an Anticoagulant for Massive Pulmonary Hemorrhage after Living-Donor Lobar Lung Transplantation,” The Journal of Thoracic and Cardiovascular Surgery, Vol. 124, No. 3, 2002, pp. 626-627.
http://dx.doi.org/10.1067/mtc.2002.125638
