O-119
ARE PATIENTS WITH KARTAGENER'S SYNDROME WITH SITUS VISCERUM INVERSUS AT AN UNACCEPTABLY HIGH TECHNICAL RISK TO BE CONSIDERED FOR LUNG TRANSPLANT?

Objectives: In this study we suggest a number of technical points for lobar transplantation in Kartagener's syndrome in order to overcome the combined issues of situs viscerum inversus and donor/recipient size discrepancy.

Case description: A 44-year-old woman with complete situs viscerum inversus and end-stage respiratory failure secondary to Kartagener's syndrome underwent double lung transplantation using a lobar graft. The estimated donor to recipient TLC ratio was 1.01. The transplant was approached through a bilateral anterolateral thoracotomy in the 4^th intercostal space. A whole left graft implanted first in the left chest. Mimicking a right anatomy, the left main recipient bronchus was shorter and smaller than the left main bronchus of the donor, requiring an end-to-end anastomosis with partial telescoping. The donor pulmonary artery was cut longer than usual and angled at 30 degrees in order to keep a proper hilar alignment and to avoid kinking of the artery. The size of the right chest cavity was significantly reduced compared to the left side and required the use of a lobar (middle and lower lobe) graft. A post-implantation lobectomy was avoided in order to prevent unnecessary bronchial sutures. The whole donor atrial cuff was used for the anastomosis by stapling the upper vein. Part of the bronchus intermedius was preserved and used as a cuff for the anastomosis with the larger recipient bronchus. The recipient pulmonary artery had a complete left-like anatomy and was divided distally to the second mediastinal branch in order to reach the pulmonary artery of the graft. The postoperative course was uneventful and no vascular or bronchial complications were recorded. The patient is alive and well at a four year follow-up.

Conclusion: A limited number of case reports of lung transplantation have described the technical issues related to the difficult anatomy of the chest in patients with Kartagener's syndrome.

Disclosure: No significant relationships.