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Right Pneumonectomy for Right Lower Lobe Lung Cancer with Partial Anomalous Pulmonary Venous Connection in Another
Ryosuke Kaku1, Atsuko Watanabe1, Makoto Yoden2
1Division of Thoracic Surgery, Center for Respiratory Diseases, National Hospital Organization Kyoto Medical Center, Kyoto, Kyoto, Japan.
Introduction:
Partial anomalous pulmonary venous connections (PAPVC) are rare. We report a case of right pneumonectomy for right lower lobe lung cancer, wherein a PAPVC was detected in the right upper lobe vein before surgery.
Case Presentation:
A 71-year-old man was diagnosed with a mass in the right lower lobe on chest CT. Non-small-cell lung cancer was diagnosed using bronchoscopy. Right bilobectomy (middle and lower lobes) was planned to secure a margin for resection due to hypoplasia of the middle lobe; however, preoperative contrast-enhanced CT revealed a PAPVC involving the right upper lobe. If a PAPVC is identified in a non-resected lung lobe, the patient is at risk of postoperative right heart failure. In cases of PAPVC in a non-resected lobe with Qp/Qs ≥1.5, preoperative or intraoperative revascularization is recommended. Echocardiography demonstrated a pulmonary to systemic flow ratio (Qp/Qs) of 1.39; however, right heart catheterization showed an increase in Qp/Qs to 1.66. Therefore, we considered repairing the right upper pulmonary vein. However, owing to the unstable position of the right upper lobe and the length of the repaired vessel, we performed a right pneumonectomy considering the risk of vascular flexion and occlusion. The postoperative course was uneventful, and echocardiography performed 3 months after the procedure revealed an ejection fraction of 57%.
Conclusions:
In the present case, by assessing Qp/Qs using both echocardiography and right heart catheterization, we determined an appropriate surgical approach. However, right pneumonectomy is a risk factor for right-sided heart failure, and limited resection or nonsurgical treatment should be considered in certain cases. The presence of PAPVC in a non-resected lung requires caution when selecting the surgical approach. In cases of PAPVC, detailed preoperative CT evaluation is essential.
