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Following Revascularization of Ischemic Lungs

Spencer Brown, MD; Donald Mulder, MD; Gerald Buckberg, MD

AMA Arch Surg. 1974;108(6):795-797.

Abstract
While revascularization of acutely ischemic regions of the brain may result in hemorrhagic infarction, this is not a recognized hazard of pulmonary revascularization. Three patients recently entered the UCLA Medical Center with severe pulmonary ischemia (obstructed tricuspid valve prosthesis, obstructed atrial baffle following repair of transposition of the great vessels, massive pulmonary embolism) and died from massive tracheobronchial hemorrhage following successful surgical restoration of pulmonary blood flow. In each patient, severe pulmonary edema developed while left atrial pressure was below normal, indicating loss of lung capillary integrity. There was an inverse relationship between the duration of preexisting ischemia and the onset of rapidity of developing hemorrhagic infarction following restoration of normal pulmonary blood flow. This observation suggests that the lung capillary wall may be at least partially protected by collateral circulation when the ischemia develops slowly. Awareness of this potentially lethal complication may allow for earlier and more appropriate management.

Author Affiliations
Los Angeles

From the Department of Surgery, US Naval Hospital, Long Beach, Calif (Dr. Brown) and the Division of Thoracic Surgery, UCLA Medical Center, Los Angeles (Drs. Mulder and Buckberg).

Footnotes
Accepted for publication Feb 13, 1974.

Read before the annual meeting of the Southern California Chapter of the American College of Surgeons, Palm Springs, Calif, Jan 19, 1974.

Reprint requests to Division of Thoracic Surgery, UCLA Medical Center, Los Angeles, CA 90024 (Dr. Buckberg).

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