These findings indicate that despite worsening of lung function by approximately 30% after pneumonectomy, most patients can adjust to living with only 1 lung. Pulmonary hypertension is uncommon and in most cases only mild to moderate.

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A 67-year-old man diagnosed with severe aortic stenosis was admitted to our institution with pulmonary edema. The patient had a history of severe pulmonary fibrosis (total lung capacity, 57% of predicted value; diffusing capacity for carbon monoxide, 33% of predicted value) and had undergone coronary bypass grafting and mitral valve replacement with a St Jude mechanical valve (St Jude Medical, St Paul, Minn) 18 years ago. Doppler echocardiography showed a mean aortic gradient of 36 mm Hg, an aortic valve area of 0.50 cm 2 , and a left ventricular ejection fraction of 45%. Although the mean predicted operative mortality by the Society of Thoracic Surgeons score was 7.5%, the patient was considered at too high risk for surgical aortic valve replacement because of his pulmonary condition, and he was then evaluated for percutaneous aortic valve implantation (PAVI). Transesophageal echocardiography (TEE) showed an aortic annulus of 23 mm as well as proximity between the mitral prosthesis and the aortic annulus ( Figure 1A). Contrast computed tomography showed the presence of moderate stenosis and severe calcification of both iliofemoral arteries precluding transfemoral PAVI, and the patient was then proposed for transapical PAVI.The procedure was performed in the operating room under TEE and fluoroscopy guidance by a team of cardiac surgeons and interventional cardiologists using the techniques extensively described in previous reports. [1][2][3] Concerns about the interference of the mitral mechanical prosthesis with the expansion of the new aortic valve and the potential increased risk of valve embolization led us to perform balloon valvuloplasty by transfemoral approach with a 23-mm balloon just before thoracothomy. After valvuloplasty that showed the stability and complete expansion of the balloon, a left anterior minithoracotomy was performed to expose the apex, and 2 large pursestrings with pledgets were placed at the left ventricular apex. After puncturing the apex, a stiff guidewire was positioned in the descending aorta, and a 26F sheath was TEE images (long-axis view) showing the relationship between the mechanical valve prosthesis in mitral position and the aortic annulus before aortic valve implantation (A; white arrow indicates the lack of space between the mitral prosthesis and the aortic annulus) and after percutaneous valve implantation (B; white arrows indicate the aortic and ventricular ends of the percutaneously implanted aortic valve).From the Quebec Heart Institute/Laval Hospital, Quebec, Canada. The online-only Data Supplement is available at http://circinterventions.ahajournals.org/cgi/content/full/1/3/233/DC1.

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Chronic immunosuppression in organ transplant recipients predisposes to the development of malignant disease. The authors describe their 29-year institutional experience of bronchogenic carcinoma developing after heart and lung transplantation. Seven cases of bronchogenic carcinoma were diagnosed in 1,119 heart and lung transplant recipients. Computed tomography scans and radiographs at time of diagnosis, as well as prior radiographs available in six patients were retrospectively analyzed by two radiologists in consensus. The seven cases involved six heart and one lung transplant recipients. Six patients were smokers with a mean smoking history of 66 pack-years. Mean time interval from transplantation to cancer detection was 25 months. Radiologic findings consisted of a solitary pulmonary nodule (n = 3), mass with satellite nodules (n = 1), and obstructive pneumonitis (n = 1). In the sixth patient, the cancer was not radiographically visible because of obscuration by adjacent fibrosis. On review, radiographic abnormalities were present a mean of 12 months prior to diagnosis in 66% of patients. In the heart or lung transplant population, bronchogenic carcinoma develops in recipients with extensive smoking histories. It presents radiographically as a nodule, mass, or obstructive pneumonitis, and is usually visible on radiographs before the time of diagnosis.