ABSTRACT
Between February 1988 and December 1989, 15 combined heart-lung, 2 double lung and 5 single lung transplants were performed at our institution for end stage lung disease. The indication for heart-lung transplantation was primary lung disease with associated secondary heart failure in 11 cases, diffuse pulmonary disease with extensive adenopathy of the hilum in 2 cases and profuse and antibiotic-resistant tracheobronchial infection due to Pseudomonas in 2 cases. A double lung transplant was performed in 2 patients with hypertensive emphysema. The indication for a single lung transplantation was emphysema in 2 cases and pulmonary fibrosis in 3 cases; in this last indication, transplantation should be performed on the right side with a slight lengthening of the main bronchus to avoid the side-effects of mediastinal shift. There were 2 early deaths, 7 secondary deaths (from the 2nd to the 5th month) due to viral or bacterial infectious complications, and 1 late death in the 7th month (infection due to a syncitial virus). All 12 surviving patients have an excellent functional result; the size of the tracheal or bronchial anastomosis ranges from 85% to 100% of normal. From this experience, we conclude that specificity and severity of lung hazards are mainly related to bronchial infection, dependence on steroids and pleural adhesions. Moreover, posttransplant pulmonary oedema, mucociliary dysfunction and the differential diagnosis between rejection and infection require careful endobronchial suction and periodical sampling.
Subject(s)
Cystic Fibrosis/surgery , Heart-Lung Transplantation , Hypertension, Pulmonary/surgery , Lung Transplantation , Pulmonary Emphysema/surgery , Adult , Female , Heart-Lung Transplantation/mortality , Humans , Lung Transplantation/mortality , Male , Risk FactorsABSTRACT
Twenty healthy volunteers entered a study to assess cardiopulmonary responses, as measured by pulse oximetry, following changes in posture in the dental chair and the administration of Diazemuls (diazepam) in doses sufficient to instill sedation (up to a maximum dose of 20 mg) in the volunteers to a degree such that ptosis was seen. The results indicate that SaO2 values remained above 95 per cent throughout the study. It is concluded that although changes in SaO2 and pulse rate do occur, these differences are not important in healthy individuals, although they may be more serious in patients with pre-existing cardiopulmonary disease.
Subject(s)
Conscious Sedation , Diazepam/administration & dosage , Oxygen Consumption/drug effects , Posture , Pulse/drug effects , Adolescent , Adult , Anesthesia, Intravenous , Anesthesia, Local , Female , Humans , Male , Oximetry , Oxygen/blood , Supine Position , Time FactorsABSTRACT
Known for its reliability, transoesophageal echocardiography is an investigation which is increasingly used in cardiology, cardiac surgery and intensive care units. It is a semi-invasive investigation of which oesophageal perforation is a very rare but serious complication. Two cases of oesophageal perforation after transoesophageal echocardiography are reported out of a series of 87 oesophageal perforations treated between January 1981 and February 1999. In both cases, transoesophageal echocardiography was performed in conscious patients without known pre-existing oesophageal pathology. The presentations were acute. Both patients underwent emergency surgery. One patient is alive and the other one died one month after a second operation related to the perforation. Nine cases of oesophageal perforation have been reported after transoesophageal echocardiography. The pathogenesis, means of prevention and treatment of oesophageal perforation are discussed.
Subject(s)
Echocardiography, Transesophageal/adverse effects , Esophageal Perforation/etiology , Aged , Aged, 80 and over , Esophageal Perforation/surgery , Female , Humans , Male , Reoperation , Retrospective Studies , Treatment OutcomeABSTRACT
The post operative evaluation and endoscopic follow-up of 34 tracheal or bronchial anastomoses after lung or heart-lung transplantation show some aspects of the tracheobronchial healing and difficulties in the healing process: primary type I mucomucosal healing in only 6 cases, secondary type II mucosal healing in 15, delayed type III healing after mucosal or deep parietal necrosis in 13, type IV distant ulcerations of mucosa and spur lesions in 12. Type III difficulties of healing mainly occur after double-lung transplantations which always suffer from ischemia. Autologous tracheal or bronchial sutures in 3 transplanted patients submitted to standard immunosuppressive therapy including corticosteroids were uneventful and type I. This experience suggests that among all factors having an influence on bronchial healing, ischemia of the donor tracheobronchial tree is predominant, justifying all attempts of bronchial revascularization after double-lung transplantation. The efficacy of the arterial revascularization is verified in 3 cases of tracheal anastomosis after double-lung transplantation with type I or II tracheal healing.