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Pericardial Constriction Post-Lung Transplant
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Abstracts
postoperative days, the remaining two cases occurring at postoperative days 8 and eleven. There is a higher reported incidence of torsion of left lobes compared to right lobes (7 verses 3). Predisposing factors proposed were size discrepancy between the donor lung and the thoracic cavity (1 case), presence of a complete fissure in the donor lung (3 cases), or a combination of these two factors (2 cases). Four cases did not identify a predisposing factor. Two cases were successfully managed with detorsion of the affected lobe. Six cases underwent lobectomy and one case of incomplete torsion was successfully conservatively managed. Conclusion: All the reported cases illustrate surgeons and transplant physicians should be aware of this rare complication of lung transplantation. A high degree of suspicion is required in the postoperative lung transplant recipient who experiences acute respiratory insufficiency. Lobectomy is indicated when the lobe is nonviable. Simple detorsion may be tried even in cases of late diagnosis. We recommend checking anatomical structures carefully before thoracotomy closure, especially during a second thoracotomy for haemostasis, and when the graft has a complete fissure. http://dx.doi.org/10.1016/j.hlc.2015.12.075 Pericardial Constriction Post-Lung Transplant Georgina Stephens *, Dr Krishna Bhagwat, A/Prof Silvana Marasco, Prof David McGiffin The Alfred Hospital, Melbourne, VIC, Australia Purpose: To review all cases of pericardial constriction following lung transplantation in the literature, with the addition of two further cases occurring at The Alfred Hospital. Methodology: A literature review was undertaken to find all reports of pericardial constriction following lung transplantation. Cases were examined to determine demographic details of patients, presenting symptoms and signs, underlying pathology resulting in transplantation, whether pericardiotomy occurred during transplantation, management, pathological findings and outcomes. Results: Nine cases of pericardial constriction post-lung transplantation have been reported. All cases presented with symptoms and signs of biventricular failure. Pericardiotomy at time of transplant was reported in six cases, but not mentioned in the remaining three. All cases underwent pericardiectomy. Seven cases commented on pathological findings of the pericardium. Six cases reported pericardial fibrosis. One case identified fungal infection, which was the only case with a proven aetiology for pericardial constriction. Follow-up was reported in 8 cases. Six patients returned to baseline function or were reported to be doing well post-pericardiectomy. Two patients passed away during follow-up, but not directly related to pericardial constriction. Conclusion: Pericardial constriction lung transplantation is a rare but now well-described entity, with no identified aetiology in the absence of infection. A high index of suspicion for pericardial constriction should be held in lung transplant patients who present with evidence of cardiac failure, if
more common pathologies have been excluded. Pericardiectomy is the only option for definitive management. http://dx.doi.org/10.1016/j.hlc.2015.12.076 Informed Consent: Impact of full disclosure on public reporting of surgeon specific outcome data Elizabeth Suthers *, Sonia Chanchlani, Ben Dunne, Christopher Merry Fiona Stanley Hospital, Perth, WA, Australia Purpose: To examine the history and case law surrounding informed consent with a focus on Australian law and the implications for surgeon specific outcome data. Methodology: A literature review of relevant case law, significant judgments, and legal precedents was undertaken. Results: Under the influence of common law (the doctrine of precedent), Australian medico-legal practices have evolved over time. Litigation to define informed consent first occurred in 1767 England, Slater vs Baker and Stapleton, which determined that a patient has the right to be informed of what will happen to him. The case of Schloendorff v Society of New York Hospital (1994) determined that the patient has autonomy: the right to make decisions regarding themselves. Until the 1990s, Australia’s attitude toward informed consent followed that of England taking into consideration the Bolem principle, summarised as the legal requirement of duty of care towards the patient, with the standard of care being determined by a reasonable body of medical practitioners. The major change came with the judgment of Rogers v Whitaker in 1992, which overturned the Bolem principle as inapplicable in Australian law, instead determining that the patient must be provided with all the relevant information, as it applies to the individual patient and not as deemed relevant by a reasonable body of medical practitioners. Conclusion: With the current legal requirements that the patient must be provided with all relevant information, as it applies to the individual patient and not as deemed relevant by the treating clinician, this could progress to making public reporting of surgeon specific outcome data a legal requirement. http://dx.doi.org/10.1016/j.hlc.2015.12.077 Cardiac Surgery in Octogenerians: Single centre experience Sujeeth Suvarna *, Konstantinos Pechlivanidis, Delia Clune, Alexandru Cornea, Edel Costigan, Niamh Dunne, Maria Hayes, Beata Kis, Helen O’Connell, Mary O’Gorman Blackrock Clinic, Dublin, Ireland Purpose: As the relative proportion of older persons is increasing in Ireland more octogenarians are being referred for cardiac surgery. The aim of our study is to analyse our experience concerning the immediate postoperative outcomes in this sub-group of elderly population.
Abstracts
postoperative days, the remaining two cases occurring at postoperative days 8 and eleven. There is a higher reported incidence of torsion of left lobes compared to right lobes (7 verses 3). Predisposing factors proposed were size discrepancy between the donor lung and the thoracic cavity (1 case), presence of a complete fissure in the donor lung (3 cases), or a combination of these two factors (2 cases). Four cases did not identify a predisposing factor. Two cases were successfully managed with detorsion of the affected lobe. Six cases underwent lobectomy and one case of incomplete torsion was successfully conservatively managed. Conclusion: All the reported cases illustrate surgeons and transplant physicians should be aware of this rare complication of lung transplantation. A high degree of suspicion is required in the postoperative lung transplant recipient who experiences acute respiratory insufficiency. Lobectomy is indicated when the lobe is nonviable. Simple detorsion may be tried even in cases of late diagnosis. We recommend checking anatomical structures carefully before thoracotomy closure, especially during a second thoracotomy for haemostasis, and when the graft has a complete fissure. http://dx.doi.org/10.1016/j.hlc.2015.12.075 Pericardial Constriction Post-Lung Transplant Georgina Stephens *, Dr Krishna Bhagwat, A/Prof Silvana Marasco, Prof David McGiffin The Alfred Hospital, Melbourne, VIC, Australia Purpose: To review all cases of pericardial constriction following lung transplantation in the literature, with the addition of two further cases occurring at The Alfred Hospital. Methodology: A literature review was undertaken to find all reports of pericardial constriction following lung transplantation. Cases were examined to determine demographic details of patients, presenting symptoms and signs, underlying pathology resulting in transplantation, whether pericardiotomy occurred during transplantation, management, pathological findings and outcomes. Results: Nine cases of pericardial constriction post-lung transplantation have been reported. All cases presented with symptoms and signs of biventricular failure. Pericardiotomy at time of transplant was reported in six cases, but not mentioned in the remaining three. All cases underwent pericardiectomy. Seven cases commented on pathological findings of the pericardium. Six cases reported pericardial fibrosis. One case identified fungal infection, which was the only case with a proven aetiology for pericardial constriction. Follow-up was reported in 8 cases. Six patients returned to baseline function or were reported to be doing well post-pericardiectomy. Two patients passed away during follow-up, but not directly related to pericardial constriction. Conclusion: Pericardial constriction lung transplantation is a rare but now well-described entity, with no identified aetiology in the absence of infection. A high index of suspicion for pericardial constriction should be held in lung transplant patients who present with evidence of cardiac failure, if
more common pathologies have been excluded. Pericardiectomy is the only option for definitive management. http://dx.doi.org/10.1016/j.hlc.2015.12.076 Informed Consent: Impact of full disclosure on public reporting of surgeon specific outcome data Elizabeth Suthers *, Sonia Chanchlani, Ben Dunne, Christopher Merry Fiona Stanley Hospital, Perth, WA, Australia Purpose: To examine the history and case law surrounding informed consent with a focus on Australian law and the implications for surgeon specific outcome data. Methodology: A literature review of relevant case law, significant judgments, and legal precedents was undertaken. Results: Under the influence of common law (the doctrine of precedent), Australian medico-legal practices have evolved over time. Litigation to define informed consent first occurred in 1767 England, Slater vs Baker and Stapleton, which determined that a patient has the right to be informed of what will happen to him. The case of Schloendorff v Society of New York Hospital (1994) determined that the patient has autonomy: the right to make decisions regarding themselves. Until the 1990s, Australia’s attitude toward informed consent followed that of England taking into consideration the Bolem principle, summarised as the legal requirement of duty of care towards the patient, with the standard of care being determined by a reasonable body of medical practitioners. The major change came with the judgment of Rogers v Whitaker in 1992, which overturned the Bolem principle as inapplicable in Australian law, instead determining that the patient must be provided with all the relevant information, as it applies to the individual patient and not as deemed relevant by a reasonable body of medical practitioners. Conclusion: With the current legal requirements that the patient must be provided with all relevant information, as it applies to the individual patient and not as deemed relevant by the treating clinician, this could progress to making public reporting of surgeon specific outcome data a legal requirement. http://dx.doi.org/10.1016/j.hlc.2015.12.077 Cardiac Surgery in Octogenerians: Single centre experience Sujeeth Suvarna *, Konstantinos Pechlivanidis, Delia Clune, Alexandru Cornea, Edel Costigan, Niamh Dunne, Maria Hayes, Beata Kis, Helen O’Connell, Mary O’Gorman Blackrock Clinic, Dublin, Ireland Purpose: As the relative proportion of older persons is increasing in Ireland more octogenarians are being referred for cardiac surgery. The aim of our study is to analyse our experience concerning the immediate postoperative outcomes in this sub-group of elderly population.