2.1 Case 1
A 41-year old man with end stage severe PAH and right pulmonary artery atresia and giant main PAA (8 x 8 x 9cm) underwent bilateral sequential lung transplantation (figure 1). Concurrent (PA) reconstruction was planned as described in the literature.[1-5] His right lung derived its blood supply from collaterals arising from the bronchial arteries and mediastinal vessels. The entire main PA as well as the right and partly left PA were reconstructed using donor descending aorta and a bovine pericardium tube. The donor right PA did not have enough length to reach the reconstructed proximal right PA, and therefore the right PA was extended using a bovine pericardial tube (figure 2). This bovine pericardial tube was brought behind the superior vena cava and ascending aorta (figure 3).
Post operatively the PA pressures remained elevated and CT Pulmonary Angiogram (CTPA) demonstrated a mechanical cause due to kinking of the anastomosis between the bovine pericardial tube and the reconstructed proximal right PA (figure 4). At reoperation, a posterior shelf had formed due to redundancy in the length of donor aorta and this was excised and reanastomosed. The remainder of his post-operative course was uneventful, and he was discharged home day 33. He is progressing well, without activity limitations seven months after transplantation.