Lung Transplantation for Pulmonary Arterial Hypertension: Optimized Referral and Listing Based on an Evolving Disease Concept.

Pulmonary hypertension (PH) was once a devastating and fatal disease entity, the outlook of which has been significantly improved by the continued progress of medical treatment algorithms. However, some patients still ultimately fail to achieve an adequate clinical response despite receiving maximal medical treatment. Historically, lung transplantation (LTx) has been the only effective therapeutic option that could lead to satisfactory outcomes and save these advanced patients' lives. However, patients with PH tend to have the highest mortality rates on the transplant waiting list; especially after comprehensive medical treatment, they continue to deteriorate very rapidly, eventually missing optimal transplantation windows. Balancing optimized medical treatment with the appropriate timing of referral and listing has been highly controversial in LTx for patients with PH. The 2021 consensus document for the selection of lung transplant candidates from the International Society for Heart and Lung Transplantation (ISHLT) updated the specific recommendations for the LTx referral and listing time for patients with PH based on objective risk stratification. Herein, we review the evolving PH-related concepts and highlight the optimization of LTx referral and listing for patients with PH, as well as their management on the waiting list.

Synchronous resection of 12 small pulmonary nodules guided by a noninvasive 3D printed emulation model: A case report.

Localization of multiple small pulmonary nodules is the major obstacle in surgical resection. Here, we report a novel noninvasive localization technique based on a life-size 3D printed "emulation pulmonary nodule localization model" which is simple and efficient. In the case reported here of a patient with synchronous multiple pulmonary nodules, the nodules were successfully and conveniently localized without any trauma by navigation of the emulation localization model. All 12 nodules were resected precisely and thoroughly, while normal lung tissues were considerably well preserved. Pathological examination confirmed malignancy of the major nodule and some other small nodules.