EComment. The challenges of surgical management of lung pathologies with an anomalous pulmonary vein

Abstract

I read with great interest the work of Schiavon et al. in which they re-anastomosed the posterior segmental vein of the right upper lobe draining into the lower pulmonary vein during a right lower bilobectomy for lung cancer in other to avoid performing a pneumonectomy, should the vascular element be wrongfully sectioned at the surgery [1]. They went further to state that the risk of serious complications during pulmonary resection in patients with anomalous pulmonary venous connection is high and included bleeding and postoperative oedema in the residual lung amongst other complications. It is noteworthy to state that anomalous pulmonary venous connections can also occur in Sinus venosus atrial septal defects (SV-ASD) with equal challenges during surgeries for lung pathologies in these patients. An anomalous pulmonary vein with SV-ASD is defined as an interatrial defect with the right pulmonary vein draining directly into the right atrium or from the superior vena cava (SVC) or the inferior vena cava into the right atrium [2]. Besides the enumerated complications, other complications that could present a serious challenge to the thoracic surgeon are the complete transposition of the remaining pulmonary veins converting an initial acyanotic congenital cardiac problem to cyanotic one. This can occur when a left pneumonectomy is done in a patient with uncorrected SV-ASD for conditions such as tuberculosis or traumatic shattered lung. Furthermore, pulmonary venous collaterals may subsequently form, leading to systemic desaturation in the years following this surgical option [3,4]. So, for the aforementioned reasons, it is important to be watchful when considering surgical management of pulmonary pathologies in the setting of anomalous pulmonary venous connection (with or without SV-ASD) by re-implantation or re-anastomosing of the anomalous pulmonary vein to the common pulmonary vein instead of merely transecting or ligating the vessel. Conflict of Interest: None declared