Abstract
BackgroundWe previously reported that arterial infarction of vital organs after lobectomy might occur only after left upper lobectomy and be caused by thrombosis in the left superior pulmonary vein stump. We hypothesized that changes in blood flow, such as blood stasis and disturbed stagnant flow, in the left superior pulmonary vein stump cause thrombosis, and this was evaluated by intraoperative ultrasonography.MethodsFrom July 2013 to April 2014, 24 patients underwent lobectomy in the Steel Memorial Muroran Hospital. During the procedure, an ultrasound probe was placed at the pulmonary vein stump and the velocity in the stump was recorded with pulse Doppler mode. The peak velocity and the presence of spontaneous echo contrast in the stump were evaluated. After the operation, the patients underwent contrast-enhanced CT within 3 months.ResultsThe operative procedures were seven left upper lobectomies, four left lower lobectomies, seven right upper lobectomies, and six right lower lobectomies. Blood flow was significantly slower in the left superior pulmonary vein stump than in the right pulmonary vein stumps. However, that was not significantly slower than that in the left inferior pulmonary vein stump. Spontaneous echo contrast in the pulmonary vein stump was seen in three patients who underwent left upper lobectomy. Of the three patients with spontaneous echo contrast, two patients developed thrombosis in the left superior vein stump within 3 months after the operation. There was no patient who developed arterial infarction.ConclusionsIn patients who underwent left upper lobectomy, intraoperative ultrasonography to evaluate blood flow and the presence of spontaneous echo contrast in the left superior pulmonary vein stump may be useful to predict thrombosis that may cause arterial infarction.Electronic supplementary materialThe online version of this article (doi:10.1186/s13019-014-0159-8) contains supplementary material, which is available to authorized users.
Highlights
We previously reported that arterial infarction of vital organs after lobectomy might occur only after left upper lobectomy and be caused by thrombosis in the left superior pulmonary vein stump
The following patients were excluded: four patients who underwent right middle lobectomy (RML); two patients whose respiratory status exacerbated on one-lung ventilation; two patients who underwent long surgery for more than 6 hours; two patients with allergy to contrast dye; one patient with interstitial pneumonia; and one patient whose pulmonary vein (PV) was divided in the pericardium
The blood flow was significantly slower in the left superior pulmonary vein (LSPV) stump than in the right superior PV stump and the right inferior PV stump
Summary
We previously reported that arterial infarction of vital organs after lobectomy might occur only after left upper lobectomy and be caused by thrombosis in the left superior pulmonary vein stump. All 12 cases underwent left upper lobectomy (LUL). Of the previously reported 12 cases, six cases showed a thrombus in the left superior pulmonary vein (LSPV) stump [1,2,3,4,5,6]. A thrombus in the PV stump was detected in 3.3-3.6% of all patients and occurred only in patients who underwent LUL but never in patients with other lobectomies. Ichimura et al reported in their case report that a thrombus was detected in 3.4% of the patients who underwent LUL [5]. Thrombosis in the pulmonary vein stump occurs with a high frequency after LUL and may cause arterial embolism
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