Successful Infant Pneumonectomy with Unilateral Pulmonary Artery Occlusion Test

Abstract

SummaryThe use of unilateral pulmonary artery occlusion (UPAO) test for the preoperative evaluation of pneumonectomy was reported in adult patients. On the contrary, in infants, no strategies have yet been recommended to predict hemodynamics after pneumonectomy, nor has use of the UPAO test been reported. We describe the first case of infant with abnormal pulmonary circulation in whom successful pneumonectomy was performed after preoperative evaluation using UPAO test. Right pneumonectomy was planned for an 8-month-old girl, because of decreased right pulmonary function, high risk of pneumothorax, and impaired left lung expansion due to overexpansion caused by severe left bronchial stenosis and bronchomalacia. However, she had also prolonged pulmonary hypertension and there was difficulty in accurate echocardiographic evaluation of its severity due to concomitant left pulmonary artery stenosis. Furthermore, contrast-enhanced computer tomography suggested a certain degree of right pulmonary venous flow, discordant with the result showing scarce right pulmonary flow in perfusion scintigraphy. Predicting postoperative hemodynamic changes was therefore considered difficult. To evaluate these concerns, we performed cardiac catheterization and UPAO test to simulate postoperative hemodynamics. Pulmonary arteriography showed decreased but significant right pulmonary arterial and venous flows. Measurements including pulmonary artery pressure and cardiac index showed no marked changes after occlusion. Based on UPAO test results, the operation was successfully performed and hemodynamics remained stable postoperatively. The UPAO test may be useful for infants with cardiopulmonary impairment to evaluate the tolerability of pneumonectomy.(Int Heart J 2018; 59: 237-239) Key words: Preoperative evaluation, Pulmonary hypertension, Pulmonary artery stenosis P neumonectomy is rarely performed for children, but it is the principal treatment for severe congenital lung malformations, including congenital pulmonary airway malformation (CPAM). Postoperative decreases in lung volume lead to reduced ventilation and a decrease in the pulmonary vascular bed, resulting in an increased risk of pulmonary hypertension and right heart failure.1) For adult patients, several preoperative assessments have been used to predict postoperative complications for lung resection, including both lung function tests and imaging tests.2) In addition, the unilateral pulmonary artery occlusion (UPAO) test is performed to assess the safety of surgery for patients considered to have reduced cardiopulmonary function and simulates a decrease in the pulmonary vascular bed after pneumonectomy.3) On the contrary, because lung function tests are not applicable for infants, preoperative evaluations rely solely on imaging tests. No strategies have yet been recommended for predicting complications affecting cardiopulmonary function after pneumonectomy in infants, nor has use of the UPAO test been described. We present the case of an infant for whom postoperative complic...

Perioperative Sildenafil Therapy in Pediatric Congenital Cardiac Disease Patients

“…This disease needs cardiopulmonary bypass surgery, after which temporary pulmonary endothelial dysfunction and suppression of endogenous NO production would occur, re-sulting in an increased risk of heart failure. 4,5) What is more, the preoperative dynamic PH may be aggravated by an even worse postoperative PH. Historically, there have been a few rigorous clinical protocols of PH therapies in pediatric patients.…”