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.