• Journal of Chest Surgery
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• v.43 no.3
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• pp.280-284
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• 2010

Background: The postoperative management following lung transplantation has dramatically improved in the recent decade. However, some complications still remain as troublesome problems. We retrospectively reviewed the gastrointestinal complications and their management after lung transplantation. Material and Method: We performed a retrospective review of the medical records of 25 cases in 23 patients who underwent lung and heart-lung transplantations from July 1996 to March 2009. The definition of gastrointestinal complication was the gastrointestinal tract-related disease that occurred after lung transplantation. There were eight postoperative deaths (within postoperative 30 days) that were excluded from the analysis. Result: Twenty three gastrointestinal complications occurred in 11 (64.7%) of the 17 cases. The median follow-up period was 6.9 months (range: 2 months to 111 months), and chronic gastritis (23.5%, 4 of 17 cases) was the most common complication. Severe, prolonged (more than 2 weeks) diarrhea occurred in 3 cases. Three patients had gastric ulcer with one case requiring gastric primary closure for gastric ulcer perforation. This patient had gastric bleeding due to recurrent gastric ulcer 2 months after laparotomy. Cytomegalovirus gastritis and esophagitis occurred in 2 cases and 1 case, respectively, and esophageal ulcer occurred in 2 cases. There were esophageal strictures in 2 patients who underwent esophageal stent insertion. Other complications were one case each of ileus, early gastric cancer requiring endoscopic mucosal resection, gall bladder stone accompanied with jaundice, and pseudomembranous colitis. Conclusion: The incidence of gastrointestinal complication is relatively high in patients after they undergo lung transplantation. Since gastrointestinal complications can induce malnutrition, which might be related to considerable morbidity and mortality, close follow-up is necessary for the early detection and proper management of gastrointestinal complications.

• Journal of Chest Surgery
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• v.37 no.12
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• pp.1015-1018
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• 2004

Lymphangioleiomyomatosis (LAM) is a rare disease in women in childbearing age leading to progressive respiratory failure. LAM is characterized by an abnormal harmartomatous proliferation of smooth muscle cells surrounding the blood vessels, lymphatics and airways in the lung. This proliferation leads to airway obstruction, cystic alveolar change and lymphatic obstruction. Patients present with dyspnea, pneumothorax, cough, chest pain, hemoptysis, and chylous effusion. Although lung transplantation is the only therapeutic modality in end-stage LAM with respiratory failure, there has not been any report of successful treatment in Korea. We report one case of successful left single lung transplantation in a 40 year old woman suffering from end-stage LAM.

• Journal of Chest Surgery
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• v.30 no.11
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• pp.1055-1061
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• 1997

In the field of the experimental lung transplantation, we analyzed the CT findings of acute rejection, infection in the left single allotransplanted lung of adult mongrel dogs, and the CT findings were compared with the histological findings obtained by the lung biopsy Twenty two adult mongrel dogs were divided into two groups(Donor and recipient group). Donor lungs were flushed with LPDG(low pota,ilium dextral glucose) solution(n=4) or modified Euro-collins solution(n=7) and preserved over 20 hours with $10^{\circ}C(1$ case preservation for 4hours). After left single lung transplantation, the chest X-ray and sequential computed tomogram were performed with concomitant hemodynamic study and arterial blood gas analysis on immediate postoperative period, postoperative 3rd day and postoperative 7th day. Two of eleven transplanted lungs had acute rejection which was represented as moderate infiltration at immediate or 1st postoperative d y but became extensive infiltration at postoperative 3rd day on CT. There were showed one case of bronchopleural fistula, six cases of pneumonia and two cases of pulmonary infarction. In one rejection cases, the opacity of transplanted lung was improved by injection of methylprednisolone 500mg daily during 3 days. We concluded that CT was a useful noninvasive evaluation parameter after lung transplantation and the serial CT scan enabled early detection of acute rejection.

• Journal of Chest Surgery
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• v.36 no.6
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• pp.418-421
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• 2003

Heart-lung transplantation is a widely accepted treatment for Eisenmenger'syndrome. The patient is a 41-years-old male diagnosed with Eisenmenger'syndrome due to patent ductus arteriosus. The pressures were checked as follows: aorta 130/80 mean 100 mmHg, pulmonary artery 130/80 mean 109 mmHg, and right ventricle 130/20 mmHg, right atrium mean 20 mmHg. The patient needed heart-lung transplantation due to enlarged right pulmonary artery (diameter 7.5 cm). The donor was a 24 years-old male diagnosed as brain death due to subdural hematoma. Ligation of patent ductus arteriosus was performed under the cardiopulmonary bypass followed by heart-lung transplantation. Patient was extubated on postoperative day one, transferred to the general ward on day 3, and was discharged on postoperative day 33. Cardiac and lung biopsy was performed on postoperative day 41 with no signs of rejection.

• Journal of Chest Surgery
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• v.38 no.9 s.254
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• pp.656-659
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• 2005

Pulmonary mucormycosis is very rare but has a devastating opportunistic fungal infection in immunocompromised hosts. The infection usually occurs in patients with hematologic malignancy, chronic renal failure, diabetes mellitus, or in solid organ transplant recipients. We experienced a case of pulmonary mucormycosis associated with renal cadeveric allograft recipient who had uncontrolled diabetes mellitus. The patient was successfully treated by surgical resection with Amphotericin B therapy.

• Journal of Chest Surgery
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• v.30 no.8
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• pp.827-832
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• 1997

Lung volume reduction surgery(LVRS) has recently been advocated as an alternative or a bridge to lung transplantation for patients with evere dibbling emphysema. This procedure is a palliative treatment performed to alleviate the dyspnea of patients with emphysema and improve performance in the activities of daily living. The rationale of lung volume reduction for generalized emphysema is that the removing of the diseased and functionless lung may improve the function of remaining, less diseased lung. The factors critical to the success of LVRS are careful patient selection, accurate localization of target areas, meticulous anesthetic and operative technique, and intensive postoperative support. We have experienced a case of severe emphysema in a 59-year-old male patient. After selection process and pulmonary rehabilitation, the patient was treated with video-assisted thoracoscopic LVRS and the post-operative course was uneventful.

• Proceedings of the KTCVS Conference
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• 1995.10a
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• pp.117-117
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• 1995

• Journal of Chest Surgery
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• v.31 no.6
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• pp.610-614
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• 1998

The first heart-lung transplantation in Korea was successfully performed. The recipient was a 11 year old girl with pulmonary atresia with intact ventricular septum. She had been catheterized at the ages of 4 months, 3 years, 7 years and 10 years, which revealed that neither Fontan nor biventricular repair was feasible. The donor was a traffic accident victim, a 9 year-old boy with the same blood type. The donor was pronounced dead according to the guidelines of the Korean Medical Association's Brain Death Committee. The operation was performed on April 20, 1997. The native heart-lung block was explanted segmentally and donor one was placed above the phrenic nerve using the Arizona technique. After the tracheal anastomosis with single continuous 4-0 prolene, both vena cavae were anastomosed, followed by aortic anastomosis. The graft ischemic time was 145 minutes. The postoperative course was complicated by fever and tracheal stenosis at the anastomosis site. The fever was controlled by anti-tuberculous medications and the tracheal stenosis was relieved by stent(Palmaz 8 mm, 30 mm in length) placement on POD #71. The patient is doing well and is very active in her 7th postoperative month.

• Journal of Chest Surgery
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• v.30 no.12
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• pp.1219-1224
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• 1997

Although several reports were presented recently about bronchial arterial revascularization in clinical lung transplantation, one factor peculiar to the lung transplantation is the ischemia of the donor bronchus. Poor bronchial healing occurs frequently following clinical lung transplantation and this has been major cause of mortality and morbidity. There have been many attempts to solve bronchial anastomotic complications. Telescoping technique, one of those attempts, was advocated by San Antonio Group recently. This experiment was per(armed to evaluate the effect of telescoping anastomotic technique upon th healing of the tracheo-bronchial anastomosis. We used rabbits(weighing about 800 g) as experimental animal. Method: Resection of middle one third of cervical trachea and reanastomosis was performed by simple interrupted anastomotic technique in Group 1(n=15) and by telescoping anastomotic technique in Group 2(n= 15). Result: Anastomotic sites in the telescoping technique group showed significant increase of fibrosis in the early postoperative days(< Sdays) and remarkable band-like fibrous union compared to the simple interrupted group.

• Proceedings of the KTCVS Conference
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• 1994.04a
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• pp.4-9
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• 1994