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. 2014 Sep 18:9:159.
doi: 10.1186/s13019-014-0159-8.

Blood stasis may cause thrombosis in the left superior pulmonary vein stump after left upper lobectomy

Kazuto Ohtaka, Yasuhiro Takahashi, Satoko Uemura, Yasuhito Shoji, Satoshi Hayama, Tatsunosuke Ichimura, Naoto Senmaru, Yasuhiro Hida, Kichizo Kaga, Yoshiro Matsui

Blood stasis may cause thrombosis in the left superior pulmonary vein stump after left upper lobectomy

Kazuto Ohtaka et al. J Cardiothorac Surg. .

Abstract

Background: 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. 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.

Methods: From 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.

Results: The 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.

Conclusions: In 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.

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Figures

Figure 1
Figure 1
Intraoperative ultrasonography. An ultrasound probe is placed at the pulmonary vein stump (a). The probe is carefully placed parallel to the staple line of the pulmonary vein stump. The velocity is recorded with pulse Doppler mode (b). The peak velocity in the pulmonary vein stump is measured. RIPV: Right inferior pulmonary vein.
Figure 2
Figure 2
Velocity in the pulmonary vein stump. Blood flow is significantly slower in the left superior pulmonary vein stump than in the right pulmonary vein stumps. However, that is not significantly slower than in the left inferior pulmonary vein. LIPV: Left inferior pulmonary vein, LSPV: Left superior pulmonary vein, RIPV: Right inferior pulmonary vein, RSPV: Right superior pulmonary vein.
Figure 3
Figure 3
Spontaneous echo contrast in the pulmonary vein stump. Ultrasonographic images in the left superior pulmonary vein stump show the absence (a) and the presence of spontaneous echo contrast (b). PV: Pulmonary vein.
Figure 4
Figure 4
A comparison of velocity of PV stump between SEC positive group and negative group in the patients who underwent LUL. There was no significant difference of flow in the LSPV stump between SEC positive group and SEC negative group. Of the three patients with SEC, two patients developed thrombosis in the LSPV stump (black circle).
Figure 5
Figure 5
Thrombosis in the left superior pulmonary vein stump. In the patient who showed SEC in the left superior pulmonary vein stump on intraoperative ultrasonography, thrombosis in the stump is seen on contrast-enhanced computed tomography.
See this image and copyright information in PMC

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