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Late complications. Late respiratory failure.

J M Wihlm¹, G Massard

¹Department of Thoracic Surgery, Hôpitaux Universitaires de Strasbourg, France. Jean-Marie.Wihlm@chru-strasbourg.fr

Chest Surgery Clinics of North America

|August 25, 1999

Summary

Respiratory failure after pneumonectomy has many causes. Two specific, curable conditions are post-pneumonectomy syndrome and platypnea-orthodeoxia syndrome, often linked to heart issues.

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Area of Science:

Cardiology
Pulmonology
Thoracic Surgery

Background:

Respiratory failure is a common complication following pneumonectomy.
Causes are diverse, ranging from pulmonary hypertension and disease recurrence to effusions and chemotherapy side effects.
Acute conditions like pneumonia and pulmonary embolism also present challenges.

Purpose of the Study:

To analyze the causes of late and progressive respiratory failure post-pneumonectomy.
To specifically investigate the mechanisms, presentation, and diagnosis of two curable syndromes: post-pneumonectomy syndrome and platypnea-orthodeoxia syndrome.
To highlight the importance of suspecting and diagnosing these specific conditions.

Main Methods:

Comprehensive literature review of hemodynamic and anatomical mechanisms.
Analysis of clinical presentations associated with post-pneumonectomy respiratory failure.
Evaluation of diagnostic approaches for identified syndromes.

Main Results:

Identified non-specific causes: restrictive failure, pulmonary hypertension, disease recurrence, treatment side-effects, and effusions.
Highlighted acute causes: heart failure, pulmonary embolism, and pneumonia.
Detailed the platypnea-orthodeoxia syndrome as a right-to-left interatrial shunt via a reopened patent foramen ovale.

Conclusions:

Late respiratory failure post-pneumonectomy necessitates a broad differential diagnosis.
Post-pneumonectomy syndrome and platypnea-orthodeoxia syndrome are specific, benign, and treatable causes.
Early suspicion and diagnosis of these syndromes are crucial for effective patient management.

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