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The Annals of Thoracic Surgery, Vol 54, 638-650, Copyright © 1992 by The Society of Thoracic Surgeons
HC Grillo, JA Shepard, DJ Mathisen and DJ Kanarek
Airway obstruction may be caused by extreme mediastinal shift and rotation
after right pneumonectomy or after left pneumonectomy in the presence of a
right aortic arch. Eleven adults (aged 18 to 58 years) with severe symptoms
were treated surgically between 5 months to 17 years after pneumonectomy (7
right, 4 left). An initial patient with only one functional lobe was
treated unsuccessfully by aortic division and bypass graft. Ten underwent
mediastinal repositioning. After two recurrences prostheses were used to
maintain mediastinal position. Five patients who underwent such
repositioning are doing well from 5 months to more than 5 years later. One
died 1 month after operation probably of pulmonary embolism. One who showed
residual airway collapse after operation has some recurrent obstruction.
Three other patients who showed severe malacic obstruction of the airway
after mediastinal repositioning variously underwent aortic division with
bypass graft and tracheal and bronchial resection. One is well almost 6
years later. Two died postoperatively. Occurrence of the syndrome is
unpredictable. Where malacic changes have not occurred, mediastinal
repositioning may reasonably be expected to correct obstruction. Optimal
treatment for concurrent severely malacic airways is unclear.
ARTICLES
Postpneumonectomy syndrome: diagnosis, management, and results
Department of Radiology, Massachusetts General Hospital, Boston 02114.
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