Delayed chest closure assessed by transesophageal echocardiogram in single-lobe lung transplantation

Area of Science:

• Pediatric surgery
• Thoracic surgery
• Transplantation immunology

Background:

• Idiopathic interstitial pneumonia in children presents significant challenges.
• Lung transplantation is a viable, albeit complex, treatment option for pediatric patients.
• Living-donor lung transplantation offers an alternative when deceased donors are unavailable.

Observation:

• A 6-year-old girl with idiopathic interstitial pneumonia underwent living-donor right single-lobe lung transplantation.
• The donor lobe was significantly larger than the recipient's chest cavity, leading to initial chest closure difficulties.
• Transesophageal echocardiography revealed compression and narrowing of the pulmonary vein anastomosis during attempted chest closure.

Findings:

• Temporary chest closure without rib approximation allowed for successful management of the oversized graft.
• Subsequent chest closure on the following day resulted in a patent pulmonary vein anastomosis, confirmed by transesophageal echocardiography.
• The patient has shown excellent recovery, with no limitations 7 months post-transplantation.

Implications:

• This case highlights the feasibility of using oversized living-donor lung grafts in pediatric transplantation.
• Innovative surgical techniques, such as temporary chest closure, can overcome anatomical challenges in complex thoracic procedures.
• Successful outcomes in pediatric lung transplantation, even in challenging cases, offer hope for improved long-term survival and quality of life.