Objective To investigate the feasibility of patent ductus arteriosus(PDA) ligation and simultaneous double-lung transplantation in the treatment of PDA and Eisenmenger syndrome and its perioperative treatment scheme.
Methods On June 27, 2014, one patient with PDA complicated with Eisenmenger syndrome underwent ligation of PDA and simultaneous bilateral sequential lung transplantation assisted under extracorporeal membrane oxygenation (ECMO) in Wuxi People's Hospital. The lung sample was excised strictly according to the standard procedures and perfused in modified low potassium dextran (LPD) solution, which was prepared by our hospital. Surgical procedures were performed precisely and properly. Intraoperative cold ischemia time of the left lung was 3.3 h and 6.0 h for the right lung. Immunosuppressive regimen of tacrolimus (FK506), mycophenolate mofetil (MMF) and adrenal cortical hormone was adopted.
Results ECMO support was discontinued when the patient had stable circulation and favorable oxygenation at postoperative 36 h. The tracheal intubation was successfully removed at 3 d after surgery. The patient suffered from acute rejection at postoperative 7 d and relieved after treatment. At postoperative 14-22 d, sputum bacterial culture yielded positive outcomes and recovered after sensitive antibiotics therapy. The patient survived at 1 year after surgery. The parameters of blood gas analysis and lung function were significantly improved. Chest CT scan displayed bilateral transplant lung explicitly and the diameter of pulmonary arterial trunk was dramatically shortened. Cardiac ultrasound examination revealed complete closure of ductus arteriosus with no residual shunt.
Conclusions PDA ligation combined with simultaneous allogeneic double-lung transplantation is a feasible approach in the treatment of Eisenmenger syndrome with right-to-left shunt. Favorable lung excision and protection, precise surgical operation and appropriate postoperative management determine the surgical success.
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