Bilateral Lung Transplantation Combined with Cardiac Correction in Treatment of Severe Pulmonary Arterial Hypertension Complicated with Eisenmenger Syndrome in Puerpera, a Feasible Strategy for Future?
Wuxi Lung Transplant Center, Wuxi People's Hospital affiliated to Nanjing Medical University, Wuxi, China
Meeting: 2020 American Transplant Congress
Abstract number: C-295
Keywords: Heart/lung transplantation, Lung transplantation, Pregnancy, Pulmonary hypertension
Session Information
Session Name: Poster Session C: Lung: All Topics
Session Type: Poster Session
Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
Location: Virtual
*Purpose: Though pregnancy is not recommended for patients with pulmonary arterial hypertension (PAH) in current guidelines, some patients do stick to parturition due to varies reasons . Previous reports regarding the management of puerperal patients with PAH complicated with Eisenmenger Syndrome (ES) usually recommend heart-lung transplantation (HLT), while other surgical methods were rarely reported. In this manuscript , we reported the successful management of 2 cases using an alternative strategy that combined bilateral lung transplantation (BLTx) with cardiac correction simultaneously. We also aim to provide an initial assumption and discuss the future clinical feasibility of this strategy in the treatment of PAH complicated with ES in puerpera.
*Methods: Two cases of severe PAH complicated with ES, who both experienced precipitate right heart failure and hemodynamic collapse shortly after the cesarean section. Though the ventilator and ECMO were applied as a bridge to recover, the patients’ conditions were further exacerbated, and the life-supporting devices could not be removed. In order to save lives, the surgical plan of simultaneous atrioventricular defect repair and double lung transplantation were scheduled after careful assessment. The surgery was performed under extracorporeal circulation. We applied the Clamshell incision, then the cardiac defects were repaired by corresponding sized patch/dacron mesh. After the heart rebeating, we performed BLTx. Postoperatively, anti-inflammation, anti-fungal treatment and a triad of tacrolimus + mycophenolate mofetil + Glucocorticoid were implemented as immunosuppressive regimens.
*Results: The ECMO device was removed on the 4th postoperative day and trachea cannula 6th of the first case, the corresponding trachea cannula was 6th of the 2nd. 2 weeks postoperatively, blood gas analysis of the two patients showed oxygenation index (OI) were 410 and 380 respectively. echocardiograms showed normal anatomy and function. Pulmonary artery systolic pressures of both patients were below 30mmHg. They remain followed-up. Their infants received artificial feeding and recovered well free of obvious complications.
*Conclusions: The strategy of bilateral lung transplantation combined with cardiac correction is of clinical feasibility in the treatment of PAH complicated with ES in puerpera. In the future, the alternative strategy maybe provide a wider operation method in some selected cases of puerpera.
To cite this abstract in AMA style:
Huang J, Wang Z, Chen J. Bilateral Lung Transplantation Combined with Cardiac Correction in Treatment of Severe Pulmonary Arterial Hypertension Complicated with Eisenmenger Syndrome in Puerpera, a Feasible Strategy for Future? [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/bilateral-lung-transplantation-combined-with-cardiac-correction-in-treatment-of-severe-pulmonary-arterial-hypertension-complicated-with-eisenmenger-syndrome-in-puerpera-a-feasible-strategy-for-future/. Accessed May 10, 2025.« Back to 2020 American Transplant Congress