Abstract
Pulmonary vein thrombosis in postoperative lung transplant patients can be associated with significant mortality and morbidity. The incidence is reported to be between 9-15%. In the acute post-operative setting, it can be difficult to clinically differentiate from primary graft dysfunction.
Retrospective analysis of patients undergoing lung transplantation at our institution from Jan 1, 2011 to Nov 15, 2012 was done to determine the incidence of pulmonary venous thrombosis. Transesophageal echocardiogram (TEE) is part of our diagnostic algorithm for primary graft dysfunction (PGD).
A total of 232 patients underwent lung transplants at our institution between Jan 1, 2011 and Nov 15, 2012.4 patients were diagnosed with anastomotic pulmonary vein thrombosis giving an incidence rate of 0.9%. 4/4 patients had radiological infiltrates and decreased PaO2/FiO2 ratios at 0-6 hours post operatively meeting criteria for PGD. 3/4 patients survived. All patients were diagnosed based on visualization of thrombus on TEE, with increased peak flow velocities >100cm/sec and gradients >10 mm Hg across the obstruction. 3/4 patients required extracorporeal support. 3/4 patients sustained a cerebrovascular event in the postperative period. 1 patient had a preexisting hypercoaguable state. All 4 patients underwent surgical thrombectomy, and revision of the affected venous anastomosis.
Pulmonary venous thrombosis should be part of the differential diagnosis of patients undergoing lung transplantation meeting PGD criteria. TEE is the diagnostic tool of choice. There appears to be a high rate of cerebrovascular events in these patients. Surgical thrombectomy might confer a survival advantage.
Patient CharacteristicsAge /sexP/F T0-6hrsECMO supportCVALocation of PVTOutcome42/M286VVYesLUPVAlive 1 year54/F51VV and VAYesLUPV, RUPVDied day 1248/M98noneYesLUPVAlive 6 months34/M74VVNoLUPVAlive 3 months
