Intraoperative 3D Transesophageal Echocardiography for Early Detection of Pulmonary Vascular Complications in Lung Transplantation: A Case-Based Teaching Series.
Ashley Virginia Fritz, Faiz R Saleem, Wesley L Allen et al.
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Case in brief
This case-based teaching series describes three lung transplant operations in which intraoperative transesophageal echocardiography (TEE) identified pulmonary vascular abnormalities and informed surgical decisions. In one case, accelerated pulmonary vein flow raised concern for ostial stenosis but was attributed to external retractor compression. A second patient had true right pulmonary vein stenosis requiring immediate revision. In the third, TEE detected severe right pulmonary artery narrowing, which was corrected during surgery to prevent early graft dysfunction. The cases illustrate how TEE findings can distinguish functional compression from structural stenosis and support timely intraoperative correction.
What made this case unusual
TEE identified both a retractor-related functional obstruction that mimicked pulmonary vein stenosis and true pulmonary vein and pulmonary artery narrowing requiring surgical correction.
Diagnostic / clinical pearl
In lung transplantation, assess pulmonary artery and vein anastomoses with intraoperative TEE and interpret flow acceleration alongside anatomy: external compression can mimic structural stenosis.