Single lung transplantation for alveolar micro-lithiasis: the first clinical report.

Pulmonary alveolar microlithiasis (P.A.M.) is a rare pulmonary disorder that pursues usually an asymptomatic course and can culminate in severe respiratory failure. We report a 48 year old Saudi female patient with P.A.M. who deteriorated rather steadily after the initial 18 years of asymptomatic course until a frank type I respiratory failure is established. Single lung transplantation (S.L.T.) was performed successfully and the patient returned to full daily activity and has now survived 12 months post S.L.T. The immunosuppression consisted of Cyclosporine-A 10 mg/kg/day, azathioprine (immuran) 2 mg/kg/day and prednisolone 10 mg daily. The bronchial anastomosis was done by telescoping the recipient and donor main bronchus without omental wrap. A significant bronchial stricture of the anastomotic site occurred 4 months post S.L.T. which was dilated endoscopically with good clinical and bronchoscopic result. No episodes of rejection or infection were encountered so far.

Fatal bilateral phrenic nerve injury following hypothermic open heart surgery.

A 30-year-old woman underwent mitral valvotomy for severe mitral stenosis. Extracorporeal circulation by means of cardiopulmonary bypass and systemic hypothermia, in addition to local topical hypothermia using iced saline solution and slushed ice, was used. Fatal bilateral phrenic nerve paralysis with inability to wean her from the ventilator occurred. This report is presented to illustrate the pathophysiology, pathology, and means of possible prevention of such a potentially highly fatal injury following hypothermic open heart surgery.

Central cyanosis due to prominence of the eustachian and thebesian valves.

A 9-year-old female child with serious central cyanosis was found to have right to left shunt across a large secundum atrial septal defect despite normal right-sided pressures. Preoperative cross-sectional echocardiography suggested the presence of large sinus venosus eustachian and thebesian valves as the mechanism responsible for diversion of the inferior caval and coronary sinus venous return to the left atrium across the interatrial secundum defect. Surgical excision of the unduly prominent sinus venosus valve and patch closure of the atrial septal defect resulted in complete disappearance of the cyanosis and physiological and clinical cure.

Superimposition of a mechanical valve on an impacted aortic bioprosthesis.

During reoperation for replacement of a regurgitant aortic bioprosthesis (a 23-mm bovine pericardial valve), it was judged that total removal of the valve would be difficult, and hazardous to the patient. Therefore, its leaflets were excised and its sewing ring left in situ. A 21-mm Carbomedics bileaflet mechanical valve was sutured to the bioprosthetic sewing ring and implanted in the orifice of the bioprosthesis, resulting in excellent hemodynamic performance. We report this new technique to illustrate its feasibility, safety, and efficiency, as an alternative to complete removal of defective prostheses in the aortic position.