Advertisement

General Thoracic and Cardiovascular Surgery

, Volume 66, Issue 6, pp 368–371 | Cite as

Successful conservative management of an anastomotic airway dehiscence at the left main bronchus following bilateral cadaveric lung transplantation

  • Ryo Miyata
  • Toyofumi F. Chen-Yoshikawa
  • Masatsugu Hamaji
  • Fumiaki Gochi
  • Hideki Motoyama
  • Toshi Menju
  • Akihiro Aoyama
  • Toshihiko Sato
  • Makoto Sonobe
  • Hiroshi Date
Case Report
  • 152 Downloads

Abstract

There is a dearth of data on management of anastomotic airway dehiscence following lung transplantation. Herein we report a case of successful conservative management of an anastomotic airway dehiscence after cadaveric donor lung transplantation. A 41-year-old woman with primary ciliary dyskinesia underwent cadaveric bilateral lung transplantation without cardiopulmonary bypass. On the postoperative day 25, left pneumothorax developed and bronchoscopy demonstrated a localized anastomotic dehiscence at the left main bronchus. The dehiscence was managed with 2 weeks of pleural drainage and was completely covered with regenerated bronchial epithelium at 4 months after transplantation. There is no finding suggestive of significant stenosis at 4 years of follow-up. Our case suggested asymptomatic and localized anastomotic dehiscence does not always require endobronchial stent placement or re-operation. Multiple factors that may contribute to the successful conservative management were discussed in this article.

Keywords

Cadaveric donor lung transplantation Anastomotic airway dehiscence 

Notes

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to declare.

References

  1. 1.
    Mahajan AK, Folch E, Khandhar SJ, Channick CL, Santacruz JF, Mehta AC, et al. The diagnosis and management of airway complications following lung transplantation. Chest. 2017. doi: 10.1016/j.chest.2017.02.021.PubMedGoogle Scholar
  2. 2.
    Hayes D Jr, Hatton KW, Feola DJ, Murphy BS, Mullett TW. Airway dehiscence after lung transplantation in a patient with cystic fibrosis. Respir Care. 2010;55(12):1746–50.PubMedGoogle Scholar
  3. 3.
    Anile M, Diso D, Rendina EA, Venuta F. Airway anastomosis for lung transplantation. J Thorac Dis. 2016;8(Suppl 2):S197–203.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Garfein ES, McGregor CC, Galantowicz ME, Schulman LL. Deleterious effects of telescoped bronchial anastomosis in single and bilateral lung transplantation. Ann Transplant. 2000;5(1):5–11.PubMedGoogle Scholar
  5. 5.
    Mughal MM, Gildea TR, Murthy S, Pettersson G, DeCamp M, Mehta AC. Short-term deployment of self-expanding metallic stents facilitates healing of bronchial dehiscence. Am J Respir Crit Care Med. 2005;172(6):768–71.CrossRefPubMedGoogle Scholar
  6. 6.
    De Wauwer CV, Van Raemdonck D, Verleden GM, Dupont L, De Leyn P, Coosemans W, et al. Risk factors for airway complications within the first year after lung transplantation. Eur J Cardio Thorac. 2007;31(4):703–10.CrossRefGoogle Scholar
  7. 7.
    Murthy SC, Blackstone EH, Gildea TR, Gonzalez-Stawinski GV, Feng J, Budev M, et al. Impact of anastomotic airway complications after lung transplantation. Ann Thorac Surg. 2007;84(2):401–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Yserbyt J, Dooms C, Vos R, Dupont LJ, Van Raemdonck DE, Verleden GM. Anastomotic airway complications after lung transplantation: risk factors, treatment modalities and outcome-a single-centre experience. Eur J Cardiothorac Surg. 2016;49(1):e1–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Afzelius BA. Cilia-related diseases. J Pathol. 2004;204(4):470–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Noone PG, Leigh MW, Sannuti A, Minnix SL, Carson JL, Hazucha M, et al. Primary ciliary dyskinesia: diagnostic and phenotypic features. Am J Respir Crit Care Med. 2004;169(4):459–67.CrossRefPubMedGoogle Scholar
  11. 11.
    Frija-Masson J, Bassinet L, Honore I, Dufeu N, Housset B, Coste A, et al. Clinical characteristics, functional respiratory decline and follow-up in adult patients with primary ciliary dyskinesia. Thorax. 2017;72(2):154–60.CrossRefPubMedGoogle Scholar
  12. 12.
    Kennedy MP, Noone PG, Leigh MW, Zariwala MA, Minnix SL, Knowles MR, et al. High-resolution CT of patients with primary ciliary dyskinesia. AJR Am J Roentgenol. 2007;188(5):1232–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Ferraroli GM, Ravini M, Torre M, Valvassori L, Belloni PA. Successful treatment of bronchial dehiscence with endobronchial stent in lung transplantation. Diagn Ther Endosc. 2000;6(4):183–8.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    McGiffin D, Wille K, Young K, Leon K. Salvaging the dehisced lung transplant bronchial anastomosis with homograft aorta. Interact Cardiovasc Thorac Surg. 2011;13(6):666–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Kumar A, Alraiyes AH, Gildea TR. Amniotic membrane graft for bronchial anastomotic dehiscence in a lung transplant recipient. Ann Am Thorac Soc. 2015;12(10):1583–6.CrossRefPubMedGoogle Scholar

Copyright information

© The Japanese Association for Thoracic Surgery 2017

Authors and Affiliations

  • Ryo Miyata
    • 1
  • Toyofumi F. Chen-Yoshikawa
    • 1
  • Masatsugu Hamaji
    • 1
  • Fumiaki Gochi
    • 1
  • Hideki Motoyama
    • 1
  • Toshi Menju
    • 1
  • Akihiro Aoyama
    • 1
  • Toshihiko Sato
    • 1
  • Makoto Sonobe
    • 1
  • Hiroshi Date
    • 1
  1. 1.Department of Thoracic SurgeryKyoto University HospitalKyotoJapan

Personalised recommendations