Bilateral Re-expansion Pulmonary Edema after Cardiac Surgery Successfully Treated with Venovenous Extracorporeal Membrane Oxygenation / 日本心臓血管外科学会雑誌

A 57-year-old man was admitted with high fever and chest discomfort associated with aortic valve infective endocarditis. An echocardiogram showed severe aortic valve regurgitation. An emergent operation was performed. The aortic valve was destroyed and an annulus abscess was observed. Aortic valve replacement was performed. There was a large amount of pleural effusion in both chest cavities. Bilateral chest drainage was performed. Cardiopulmonary bypass weaning was performed uneventfully. The operation was finished without any mechanical support required. However, respiratory failure was observed to progress rapidly immediately after the operation. A postoperative X-ray showed bilateral pulmonary edema. Re-expansion pulmonary edema was diagnosed. Because oxygenation was not improved in ventilator settings, venovenous extracorporeal membrane oxygenation (V-V ECMO) was installed. Respiratory support with V-V ECMO was needed for 17 days postoperatively. It took 36 days before the patient was removed from the ventilator. V-V ECMO successfully managed bilateral re-expansion pulmonary edema.

Edema pulmonar de reexpansión en avenamiento pleural por neumotórax / Re-expansion pulmonary edema afer pleural drainage of pneumothorax

Se trata de un paciente masculino de 28 años que consultó por dolor torácico izquierdo, acompañado de disnea de 4 días de evolución. La radiografia de tórax confirmó la sospecha de neumotórax izquierdo. Cuarenta minutos después de realizado el avenamiento pleural izquierdo, el paciente comenzó con tos productiva y disnea. La radiografia de tórax evidenció infltrados en el pulmón izquierdo. La tomografia computarizada de tórax confirmó el edema pulmonar de reexpansión. El paciente cursó la internación en terapia intensiva con tratamiento de soporte. Se retró el tubo de tórax al sexto día y se otorgó el alta hospitalaria.

A 28 year old man presented with lef thoracic pain and dyspnea for the four previous days. Chest X-ray evidenced a lef pneumothorax. Forty minutes afer inserton of a pleural drainage, the patent complained of dyspnea and productive cough. A new chest X-ray showed pulmonary infltrates in the lef lung. A computed tomographic scan was consistent with re-expansion pulmonary edema. The patent spent a postoperative course in the intensive care unit with suportive therapy. The pleural drain was withdrawn on the sixth day, and was discharged home.

Re-expansion Pulmonary Edema after Mitral Valve Plasty via Small Right Thoracotomy / 日本心臓血管外科学会雑誌

We report a case of re-expansion pulmonary edema (REPE), which complicated mitral valve plasy via right small thoracotomy. A 56-years old man underwent mitral valve plasty for severe mitral regurgitation caused by P2 prolapse. After separation from heart-lung machine, massive yellow foamy secretion has begun to spout from the right side endotracheal tube and hypoxemia has ensued. Differential ventilation with high airway pressure and steroid pulse therapy could not counteract the exacerbation of hypoxemia. Echocardiography showed severe diffuse hypokinesis of left ventricular wall. Intra-aortic balloon pumping and percutaneous cardiopulmonary support (PCPS) were introduced, and they were very effective. After five-days' support, PCPS was successfully weaned. The patient recovered well. REPE complicated by mini-thoracotomy approach cardiac surgery, is rare, but can be fatal.

Re-expansion Pulmonary Edema after Laparoscopic Bariatric Surgery: A case report / 대한마취과학회지

Laparoscopic procedures are accompanied by an increased intra-abdominal pressure and diaphragmatic elevation, which may interfere with adequate ventilation in obese patients. Re-expansion of a collapsed lung could be followed by pulmonary edema. Here, we describe a case of re-expansion pulmonary edema after laparoscopic bariatric surgery. A 23-year-old-female with morbid obesity received general anesthesia for laparoscopic adjustable gastric banding surgery. Unintentional one lung ventilation occurred for a short period during the operation and was promptly corrected. At the end of the operation, as spontaneous respiration recovered, profuse pinkish frothy sputum emerged from the endotracheal tube. Diffuse patchy increased opacity on the left lung field was observed by chest X-ray. With aspiration of bronchial secretion and oxygen supplementation, the patient was recovered uneventfully. We presume that inadequate lung expansion during pneumoperitoneum and unintentional right endobronchial intubation caused atelectasis of the left lung, and induced re-expansion pulmonary edema at the end of the operation. This case emphasizes the importance of constant vigilance with respect to endotracheal tube position and ventilation during laparoscopic surgery in obese patients.