Commentary on Donor Pulmonary Vein Anomalies
Authors: Suresh Keshavamurthy1, Professor. Yoshiya Toyoda2, Vipin Dulam2*, Mohammed Abul Kashem2
1Division of Cardiothoracic Surgery, University of Kentucky College of Medicine, USA
2Lewis Katz School of Medicine, Temple University, USA
*Correspondence to: Vipin Dulam, Lewis Katz School of Medicine, Temple University, USA; E-mail: vipin.dulam@temple.edu
Received: February 25, 2022; Accepted: March 09, 2022; Published: March 13, 2022
Copyright: © 2022 Keshavamurthy S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Citation: Citation: Keshavamurthy S, Dulam V and Kashem MA, Toyoda Y (2022) Commentary on Donor Pulmonary Vein Anomalies. 21st Century Cardiol, Volume 2 (2): 119
Abstract
Systemic and Pulmonary venous anomalies are uncommon and often unexpected findings during organ procurement. While systemic venous anomalies are easier to recognize during the harvest, pulmonary venous anomalies due to their inherent course are more difficult to do so and consequently a surprise either on the back table or just before the lung/s being implanted. We have reported our experience with implanting an anomalous left upper pulmonary vein, a continuation of the embryological vertical vein.
Keywords:
Systemic and Pulmonary venous anomalies; Organ procurement; Imaging
Description
Pulmonary venous anomalies are rare and often unrecognized during donor lung procurement due to lack of adequate imaging studies. They are therefore at risk for injury during harvest and present the implanting surgeon with a technical challenge [1, 2].
Among the few reports available in the literature, the anomaly was recognized on the back table [3, 4] and in one of them it was apparent after reperfusion [5].
In cases with a persistent vertical vein, recipient pericardium, donor iliac vein or a synthetic extracellular matrix conduit have been used to restore continuity. We identified the anomalous left upper pulmonary vein and anastomosed it to the recipient’s left atrial cuff whereas in another instance the left atrial appendage was used [4, 6].
Conclusion
Reviewing donor anatomy and imaging thoroughly can help identify these anomalies. However, imaging is usually without contrast and the emphasis is on assessing lung quality thereby making these anomalies difficult to identify. When picked up early it can allow the recipient team to plan reconstruction while one must improvise after it is noticed before implant.
References
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2. Belli EV, Landolfo K, Thomas M, Odell J. Partial anomalous pulmonary venous return in a lung transplant recipient. The Annals of Thoracic Surgery. 2013 Mar 1;95(3):1104-6. https://doi.org/10.1016/j.athoracsur.2012.10.037
3. Schmidt F, McGiffin DC, Zorn G, Young KR, Weill D, Kirklin JK. Management of congenital abnormalities of the donor lung. The Annals of thoracic surgery. 2001 Sep 1;72(3):935-7. https://doi.org/10.1016/S0003-4975(00)02432-2
4. Massad MG, Sirois C, Tripathy S, Jaffe HA, Snow N, Geha AS. Pulmonary venous drainage into the left atrial appendage facilitates transplantation of the left lung with difficult exposure. The Annals of thoracic surgery. 2001 Mar 1;71(3):1046-7. https://doi.org/10.1016/S0003-4975(00)02452-8
5. Khasati NH, MacHaal A, Thekkudan J, Kumar S, Yonan N. An aberrant donor pulmonary vein during lung transplant: a surgical challenge. The Annals of thoracic surgery. 2005 Jan 1;79(1):330-1. https://doi.org/10.1016/j.athoracsur.2003.08.073
6. Keshavamurthy S, Dulam V, Leung SW, Kashem MA, Toyoda Y. Donor Pulmonary Vein Anomalies: What’s in Your Toolbox?. The Annals of thoracic surgery. 2021 Nov 1;112(5):e369-71. https://doi.org/10.1016/j.athoracsur.2021.02.015