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Eur J Cardiothorac Surg 2005;28:389-393
© 2005 Elsevier Science NL

Original articles

Pneumonectomy for unilateral destroyed lung with pulmonary hypertension due to systemic blood flow through broncho-pulmonary shunts

Department of Surgery, National Hospital Organization Kinki-chuo Chest Medical Center, 1180 Nagasonechou Sakai city, Osaka 591-8555, Japan

Received 31 March 2005; received in revised form 26 April 2005; accepted 26 April 2005.

^* Corresponding author. Tel.: +81 722 52 3021; fax: +81 722 51 1372. (Email: h-tanaka{at}kch.hosp.go.jp).

Abstract

Objective: Three decades ago, a few patients with pulmonary hypertension and respiratory failure associated with a unilateral destroyed lung were reported to have been treated by a pneumonectomy. In the present study, we investigated the clinical features, operative indications, and results of four cases with pulmonary hypertension that underwent a pneumonectomy for a unilateral destroyed lung. Methods: Four patients (three males, one female) with a destroyed lung and pulmonary hypertension (mean pulmonary arterial pressure >25mmHg) were treated by a pneumonectomy between 1999 and 2002 at our institution. Their mean age was 59 years old (range 42–68 years). The underlying lung disease, Medical Research Council (MRC) dyspnea scale, respiratory function, arterial blood gas analysis, pulmonary arterial pressure, preoperative management, operative procedure, and postoperative course for each were reviewed retrospectively. Results: The underlying lung disease that caused the destroyed lung was bronchiectasis in two patients, chronic empyema with bronchopleural fistula in one, and necrotizing pneumonia in one. The average mean pulmonary artery pressure was 33mmHg (range 25–42mmHg), which decreased to 27mmHg (range 19–36mmHg) after occlusion of the pulmonary artery in the affected lung. Following the pneumonectomy, the average mean pulmonary artery pressure was decreased to 17mmHg (range 11–25mmHg). Chronic inflammatory symptoms and functional impairments (showed by blood gas analysis, pulmonary arterial pressure, or MRC dyspnea scale) improved post-pneumonectomy. There was no operative death, though postoperative cardiorespiratory failure occurred in one patient. All patients were discharged from the hospital. Conclusions: We concluded that a pneumonectomy procedure may be indicated for selected patients with a unilateral destroyed lung and pulmonary hypertension due to systemic blood flow though broncho-pulmonary shunts.

Key Words: Pneumonectomy • Destroyed lung • Pulmonary hypertension

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