Postpneumonectomy Compression of the Mitral Annulus: Rare Vascular Complication in Sportive Patient.

David Debeaumont,Florence Vincent,Tristan Bonnevie,Alain Boutry,Marie Bellefleur,Jérémy Coquart,Francis-Edouard Gravier,Marie Netchitailo,Catherine Tardif,Susana Bota,Jean-Marc Baste,Jean-François Muir,Dimitri Stepowski

doi:10.1155/2016/9575894

Abstract

Numerous postpneumonectomy complications exist. We present a rare clinical case of postpneumonectomy exertional dyspnea revealing compression of the mitral annulus by the descending aorta. The patient was 42-year-old former smoker with pulmonary emphysema. He has been operated on, in 2012 (i.e., right pneumonectomy). Before the surgery, the patient was a recreational runner. However, after some months, it was difficult for the patient to resume running. Cardiopulmonary exercise testing indicated moderate exercise intolerance with important oxygen desaturation. More interestingly, a decrease of low oxygen pulse was noticed from the first ventilatory threshold with no electrical modification on the electrocardiogram. This decrease was indicative of a decline in stroke volume. The thoracic scan revealed a right pneumonectomy pocket with a liquid abnormal content. Moreover, the mediastinum had shifted toward the pneumonectomy space and the left lung was distended and emphysematous. Echocardiography revealed a major change in the mediastinal anatomy. The mitral annulus was observed to be compressed by the rear wall of the descending aorta. The diagnosis of postpneumonectomy syndrome or platypnea-orthodeoxia syndrome was ruled out in this patient. Mitral annular compression by the descending aorta is rare complication, which must be researched in patients with postpneumonectomy exertional dyspnea.

Highlights

Postpneumonectomy syndrome is a rare complication caused by a deviation of the mediastinum following pneumonectomy [1]
We present a rare clinical case of postpneumonectomy exertional dyspnea revealing compression of the mitral annulus by the descending aorta
The cardiopulmonary exercise testing (CPX) was performed on a cycle ergometer (3-min warm-up at 30 W followed by increments of 15 W⋅min−1) and indicated moderate exercise intolerance with oxygen desaturation

Summary

Introduction

Postpneumonectomy syndrome is a rare complication caused by a deviation of the mediastinum following pneumonectomy [1]. The mediastinum shifts and rotates into the pneumonectomy space, obstructing the trachea, main bronchus, and esophagus by extrinsic compression and stretching. Vascular complications are rare in this syndrome, generally involving the reopening of a patent foramen ovale or pulmonary artery compression [2]. Only a single case of pulmonary vein compression has been described [3], revealed by exploration of postpneumonectomy exertional dyspnea. We present a rare clinical case of postpneumonectomy exertional dyspnea revealing compression of the mitral annulus by the descending aorta

Observation

Discussion

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Conclusion