A case of lung cancer associated with partial anomalous pulmonary venous connection in the lobe that should be preserved - The efficacy of a selective pulmonary arterial occlusion test -

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  • Yokota Keisuke
    Nagoya City University Graduate School of Medical Sciences Oncology, Immunology, and Surgery
  • Fukai Ichiro
    Suzuka General Hospital, Division of Thoracic Surgery
  • Shitara Masayuki
    Suzuka General Hospital, Division of Thoracic Surgery

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  • 非切除予定肺葉に部分肺静脈還流異常症を有する肺癌の手術―選択的肺動脈閉塞試験による術後右心不全リスク評価の有用性について―

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Abstract

<p>As PAPVC, a rare vascular malformation, forms left-to right shunt, lobectomy exacerbates this shunt, and might cause right heart failure in cases with malformation located in the lobe that should be preserved. A 78-year-old man with PAPVC in the right upper lobe was referred to our hospital because of an abnormal shadow noted on a chest radiograph, suspected of being right lower lobe lung cancer. To simulate the exacerbation of the shunt after the lower lobectomy, a selective pulmonary artery (PA) occlusion test was conducted using a balloon catheter, which actually blocked the inferior pulmonary trunk simulating middle and lower lobectomy. The occlusion test was easier and stricter than the test blocking the lower pulmonary artery super selectively. The oxygen saturation was calculated using blood samples from the atrium and SVC (distal side of PAPVC) to measure O2 step up between those two anatomical sites. Although O2 step up deteriorated after PA occlusion from 3.2% initially to 6.2%, the value was less than 7%, being clinically significant. The calculated pulmonary blood flow/systemic blood flow ratio (Qp/Qs) after the PA occlusion test was 1.07, which was also less than 1.5 requiring a reconstructive vascular operation to reduce the shunt. Right lower lobectomy was performed without any complications as expected, and the patient was free from recurrence and any symptoms of right heart failure as of 2 years and 3 months after uneventful discharge.</p>

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