1. The postpneumonectomy syndrome: clinical presentation and treatment
- Author
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Thomas Frauenfelder, Erich W. Russi, Dieter Hahnloser, Peter Kestenholz, Christopher Soll, Walter Weder, University of Zurich, and Kestenholz, P B
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Lung Neoplasms ,10255 Clinic for Thoracic Surgery ,medicine.medical_treatment ,Stridor ,Vital Capacity ,education ,610 Medicine & health ,2705 Cardiology and Cardiovascular Medicine ,Pneumonectomy ,FEV1/FVC ratio ,Forced Expiratory Volume ,Humans ,Medicine ,Thoracotomy ,Esophagus ,health care economics and organizations ,10217 Clinic for Visceral and Transplantation Surgery ,Aged ,10042 Clinic for Diagnostic and Interventional Radiology ,business.industry ,Mediastinum ,Heartburn ,Prostheses and Implants ,Syndrome ,General Medicine ,Middle Aged ,Dysphagia ,2746 Surgery ,Surgery ,Airway Obstruction ,Dyspnea ,medicine.anatomical_structure ,2740 Pulmonary and Respiratory Medicine ,Female ,medicine.symptom ,Deglutition Disorders ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background: Postpneumonectomy syndrome (PPS) is a rare complication after pneumonectomy. It consists of an excessive mediastinal shift resulting in compression and stretching of the tracheobronchial tree and the esophagus. The aim of this study was to give a comprehensive overview of diagnosis, variety of symptoms and evaluation of surgical treatment of PPS. Methods: We retrospectively reviewed the charts of all our patients with PPS since 1994 with respect to symptomatology, treatment and outcome. Our results were compared with case reports and case seriesintheliterature.Results:Sixwomenwithamedianageof56.5years(range49—65)developedPPSafterpneumonectomyforthetreatment of lung cancer. Four presented with a right PPS and two with a left PPS, respectively. Symptomsconsisted of shortness of breath in all patients and dysphagia as well as heartburn in two patients. Correction of PPS required re-exploration of the pneumonectomy space, reposition of the mediastinum followed by the insertion of single silicone prosthesis in five patients or fixation of the mediastinum with a xenopericardial graft in one patient. We could observe an improvement of the FEV1/FVC ratio in all our patients and the clinical improvement of shortness of breath was better than we expectedby changes of lung function.Four patients returnedto theirregular activities with a follow-up of four years. We found 73 cases of PPS in the literature, on the right side in 50 patients (68%) and on the left side in 23 patients (32%). Fifty-nine patients (81%) were treated surgically. Symptoms can be suspicious for cardiogenic origin and vary from heartburn to recurrent syncopes. Conclusion: PPS is rare and not predictable.Itcanoccurafterrightorleftpneumonectomy. Symptomsaremanifoldandresult fromashift,leadingto compressionandstretching of the two conduits located within the mediastinum, the tracheobronchial tree and the esophagus and consists of shortness of breath, stridor and heartburn. Diagnosis must be made by exclusion. Implantation of prosthesis is the most commonly used and effective treatment. # 2008 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved. more...
- Published
- 2009
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