Bilateral living-related lobar lung transplantation avoiding bronchial stenosis associated with scoliosis by modified anastomosis: a case report.

Background: Severe thoracic deformity caused by scoliosis often hampers lung transplantation (LTx) due to its underlying restrictive ventilatory dysfunction. Postoperative stenosis of the reconstructed bronchus due to spinal compression is also a complication after LTx in patients with scoliosis. Previous reports on LTx with scoliosis and its outcomes have not discussed the technical aspect of bronchial anastomosis. This report describes a case in which bronchial stenosis was avoided by modifying the angle of the right bronchial anastomosis.

Case Presentation: A 26-year-old woman with atrial septal defect (ASD), pulmonary hypertension, Eisenmenger's syndrome, and severe right scoliosis underwent bilateral living-related lobar LTx with her parents as donors followed by ASD closure. Left pneumonectomy and anastomosis preceded. On the right side, after pneumonectomy, the recipient's right main bronchus was trimmed to rotate the bronchial anastomosis clockwise by 45°. This resulted in clockwise rotation of the graft (the lower lobe of the mother's right lung), making axes of the graft and deformed vertebrae parallel. Postoperative bronchoscopy 2 months after surgery showed no evidence of compression or stenosis of the basal bronchial branch.

Conclusion: By obliquely trimming the recipient's right main bronchus to make the angle of the pulmonary graft and deformed thorax parallel, postoperative bronchial stenosis owing to severe scoliosis was successfully avoided.