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Bilateral Lung Transplantation With Interventional Occlusion of an Atrial Septal Defect in a Patient With Eisenmenger Syndrome: We report the first case With Eisenmenger syndrome secondary to an atrial septal defect (ASD) in a patient who underwent bilateral lung transplantation (BLTx) and interventional closure of the ASD in China

Chen, Jingyu; Ji, Yong; Ye, Shu Gao

doi: 10.1097/01.tp.0000520317.94454.2f
117.1
Free

Department of Cardiothoracic Surgery, Wuxi People’s Hospital, Wuxi, People's Republic of China.

On November 28, 2014, the Department of Chest Surgery of Wuxi People's Hospital in China performed the first case of an ECMO assisted bilateral lung transplantation (BLTx) combined with interventional occlusion of an ASD in a patient with Eisenmenger syndrome. The patient was then followed up for 2 years. Thus, we herein reported this case as follows.

Patient history: This female patient was 33-year-old with a body weight of 50 kg and height of 162 cm. A cardiac ultrasound examination by other hospital revealed Eisenmenger syndrome, foramen secundum atrial septal defect with right ventricular and atrial enlargement, pulmonary artery broadening and severe pulmonary hypertension (pulmonary artery systolic pressure 120 mmHg). Then, after 3 months, the patient underwent cardiac catheterization and a tentative occlusion of the ASD, but there was no marked drop in pulmonary artery pressure after occlusion, and the patient had a chief complaint of marked chest pain. Thus, the occluder was retrieved, and bosentan was taken orally to reduce pulmonary artery pressure. During treatment, the patient had presented with syncope twice and NYHA class 3–4 symptoms.

On October 20, 2014, the patient was admitted to our Hospital to undergo preoperative assessment for lung transplantation. An ECG test showed sinus tachycardia, right axis deviation, T-wave change and right ventricular hypertrophy. Chest X-ray and CT showed increased and disordered lung markings on both sides, and marked prominence of the pulmonary artery segment (Figure 1). A lung function test showed severely obstructive ventilation dysfunction. Blood gas analysis showed the partial pressure of oxygen 50 mmHg, partial pressure of carbon dioxide 35.5 mmHg, and oxygen saturation: 85-90% at rest, 91-93% at 30min after oxygen inhalation, and 60-65% at 3min after walking. A 6-minute walk test (6-MWT) result was 120m and activity was remarkably limited. Cardiac catheterization showed that the pulmonary artery pressure was equal to the systemic blood pressure [110/70 (82) mmHg] and that the pulmonary artery resistance was 19.3Wood units.

On November 28, 2014, we performed bilateral cadaveric lung transplantation with interventional closure of the ASD assisted by ECMO. Our experience of successful treatment for this patient indicates that it’s feasible approach to carry out bilateral allogeneic lung transplantation together with heart defect repair for end-stage congenital heart disease.

we agree with the article published.

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