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Ann Thorac Surg 1996;62:1627-1631
© 1996 The Society of Thoracic Surgeons

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Original Articles: General Thoracic

Postpneumonectomy Syndrome With an Ipsilateral Aortic Arch After Left Pneumonectomy

Division of Thoracic Surgery and Department of Radiological Sciences Ottawa Civic Hospital, Ottawa, Ontario, Canada; Centre de Pneumologie de l'Hôpital Laval, Sainte-Foy, Quebec, Canada; and Department of Surgery, University of Virginia Health Sciences Centre, Charlottesville, Virginia

Accepted for publication July 8, 1996.

Background. Previous reports have described bronchial obstruction after left pneumonectomy (so-called postpneumonectomy syndrome) in the presence of a right aortic arch with the bronchus being compressed between the ascending aorta and thoracic spine. This study reports on 4 patients with left postpneumonectomy syndrome in the presence of a normally located left aortic arch and ascending thoracic aorta.

Methods. The case histories of 4 patients with this syndrome were reviewed and several features common to all 4 were noted. In each case, the obstruction was thought to be due to a clockwise rotation of the mediastinum with bronchial compression occurring between the right main pulmonary artery and thoracic spine.

Results. Three patients were treated by repositioning of the mediastinum, and all 3 obtained relief of their dyspnea. In these cases, permanent repositioning was ensured by the insertion of a prosthesis filled with saline solution. The fourth patient was successfully treated by resection of a portion of the adjacent thoracic vertebra.

Conclusions. Postpneumonectomy syndrome can occur after a left pneumonectomy in the absence of a right aortic arch. We suggest that mediastinal repositioning with a prosthesis filled with saline solution is simple, is safe, and results in complete relief of preoperative symptoms.

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