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Yukinobu Goto



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    P2.05 - Interventional Diagnostic/Pulmonology (ID 168)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Interventional Diagnostics/Pulmonology
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.05-17 - Preoperative Identification of the Left Common Pulmonary Vein for Safe Video-Assisted Lobectomy (ID 2338)

      10:15 - 18:15  |  Author(s): Yukinobu Goto

      • Abstract

      Background

      The pulmonary veins (PVs) display many anatomical variations. Some anomalies, especially the common trunk of the left PV, are associated with serious surgical morbidity for patients undergoing lung surgery. Compared with thoracotomy, video-assisted thoracic surgery (VATS) has a limited view of the surgical field, thus thoracic surgeons must be familiar with anatomical variations in the PVs. We aimed to investigate the anatomical variants of the left PVs using three dimensional (3D)- computed tomography (CT) images.

      Method

      We reviewed anatomical variations of the left PVs of 156 consecutive patients who had undergone surgical pulmonary resection at our institution, using the multidetector contrast-enhanced CT. The common trunk was defined anatomically as the presence of a single ostium at the point of reflection of the parietal pericardium along the left atrium.

      Result

      We identified the common trunk of the left PV in 11 of the 156 patients (7.1%), and the discrete left lingular vein (V4+5) draining near the inferior PV in 2 patients (1.2%). Of which, 5 had the long common trunk; the length of the common trunk outside the pericardium was equal to or longer than 10mm. Of these 11 patients, 5 were men, 4 had hypertension, 3 had valvular disease, 1 had coronary artery disease, 1 had paroxysmal atrial fibrillation (Paf), and the remaining 7 had no hypertension or structural heart disease. Although the anatomical variants of PV have been related to a higher arrhythmogenic potential, only 1 (9%) patient had postoperative complication of Paf. In 11 cases, 3 had incomplete lobulation and 3 had left lingular pulmonary artery arising from pars mediastinalis. The common trunk of the left PV was accompanied by other variant anatomies, that included; 1) right V6 draining into the superior PV in 3 cases; 2) right superior vein passing dorsal to right main pulmonary artery in 1 case; 3) supernumerary bronchus corresponding to left B7 in 2 cases. We encountered three cases demonstrating a common trunk of the left PV during VATS lobectomy. 3D-CT reconstruction was useful for recognizing such anomalies before surgery and allows safe VATS lobectomy. In surgical findings, the common trunk was located in the normal superior pulmonary vein drained into the left atrium. We should expose this vein adequately and dissect peripherally for confirmation of the common trunk.

      Conclusion

      We conclude that the common trunk of the left PV is not a very rare anomaly and might be accompanied by other variant anatomies. Careful preoperative radiological evaluation of the pulmonary veins is essential to perform safe VATS lobectomy. 3D-CT can provide detailed information for assessing abnormalities of venous return.