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J Thorac Cardiovasc Surg 2002;123:1211-1213
© 2002 The American Association for Thoracic Surgery

Brief Communications

Living-donor single-lobe lung transplantation for primary pulmonary hypertension in a child

From the Departments of Surgery II,^a Cardiology,^b Anesthesiology and Resuscitology,^c and Cardiovascular Surgery,^d Okayama University School of Medicine, Okayama, Japan.

Received for publication Nov 30, 2001. Accepted for publication Dec 10, 2001. Address for reprints: Hiroshi Date, MD, Department of Surgery II, Okayama University School of Medicine, 2-5-1 Shikata-Cho, Okayama 700-8558, Japan (E-mail: hdate@nigeka2.hospital.okayama-u.ac.jp).

The use of living lung donors has saved the lives of patients who are too ill to wait on the list for cadaveric donors. ¹ In this procedure, two healthy donors are usually selected. ² One donor provides the right lower lobe, and the other provides the left lower lobe. These lobes are implanted in the recipient as the whole right and left lungs. However, finding two healthy living donors is not easy. To our knowledge, this is the first reported case of single-lobe transplantation for primary pulmonary hypertension.

Clinical summary

A 10-year-old boy had been well until 6 years old in 1998, when symptoms of dyspnea occurred during exercise. Primary pulmonary hypertension was diagnosed, and oxygen inhalation and various oral medications were initiated. In May 1999, when the patient was 8 years old, clinical deterioration required continuous intravenous infusion of prostacyclin. Despite high-dose prostacyclin therapy (90 ng · kg^-1 · min^-1), the patient remained in New York Heart Association functional class III and was unable to go to school. Right heart catheterization revealed highly elevated pulmonary arterial pressure and a reduced cardiac index (Table 1). Preoperative chest radiography demonstrated marked cardiomegaly (Figure 1, A). Two-dimensional echocardiography demonstrated a dilated hypokinetic right ventricle in association with an enlarged right atrium and pulmonary artery, with massive tricuspid regurgitation. Left ventricular function was normal apart from flattening of the interventricular septum (Figure 2, A).

View larger version (81K): [in this window] [in a new window]   Fig. 1. Chest radiography . . . [Full Text of this Article]

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