Pulmonary Vein Stenosis Following Single-Lung Transplantation Successfully Treated with Intravascular Ultrasound-Guided Angioplasty and Stent Placement
Unusual clinical course, Challenging differential diagnosis
Yash B. Jobanputra, Samir R. Kapadia, Douglas R. Johnston, Vaseem Ahmed, Brandon M. Jones, Marie Budev, Charles Randall Lane, Atul C. Mehta
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, USA
Am J Case Rep 2017; 18:1289-1295
Pulmonary vein stenosis (PVS) is a rare event following lung transplantation, but is a serious complication that requires prompt diagnosis and treatment.
CASE REPORT: We describe the case of a 60-year-old woman who underwent single-lung transplantation for idiopathic pulmonary fibrosis (IPF). One year following her single-lung transplant, she was admitted to the hospital for hypoxemic respiratory failure. The results of quantitative lung perfusion scintigraphy (LPS) raised the possibility of a diagnosis of PVS. Computed tomography angiography (CT angiography) of the chest identified more than 50% stenosis of the left common pulmonary vein at the anastomotic site with the left atrium. She was successfully treated with angioplasty and stent placement guided by intravascular ultrasonography. Post dilatation of the PVS, the pulmonary venous pressure gradient decreased from 12–16 mm Hg to 3–4 mm Hg. At three-month follow-up, the patient reported resolution of her shortness of breath. In support of this case report, we review the management of four previously reported cases from the literature of lung transplantation associated with PVS.
CONCLUSIONS: PVS should be considered in the differential diagnosis of lung transplant patients who present with worsening dyspnea. Quantitative LPS and CT angiography are important in the diagnosis of PVS. Successful management of PVS, with salvage of the transplanted lung and the prevention of further surgical interventions, may be achieved with intravascular ultrasound-guided angioplasty and stent placement.
Keywords: Angioplasty, Lung Transplantation, Postoperative Complications, Stents, Ultrasonography, Interventional