Bilateral lung transplantation with simultaneous aortic replacement using donor aorta in a patient with pulmonary arterial hypertension and patent ductus arteriosus

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Medication-refractory pulmonary arterial hypertension (PAH) complicated by patent ductus arteriosus (PDA) and giant pulmonary artery aneurysm (PAA) (n=1). Intervention: Bilateral lung transplantation with simultaneous replacement of the proximal descending thoracic aorta using a donor aortic graft and pulmonary artery trunk reconstruction. Primary outcome: Postoperative survival, hemodynamic resolution of pulmonary hypertension, and graft stability.

Q: What does this research mean for the field?

Bilateral lung transplantation with simultaneous descending thoracic aortic replacement using a donor aorta is a feasible surgical strategy for adult patients with severe pulmonary arterial hypertension complicated by a large patent ductus arteriosus. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Naoya Ishida; Hisashi Oishi; Hiromichi Niikawa; Takaya Suzuki; Hirotsugu Notsuda; Takashi Hirama; Tatsuaki Watanabe; Yui Watanabe; Takeo Togo; Ken Onodera; Sakiko Kumata; Yuyo Suzuki; Takayasu Ito; Ryuichi Taketomi; Shintaro Katahira; Kiichiro Kumagai; Yoshikatsu Saiki; Y. Okada

doi:10.1186/s13019-025-03808-w

Key result

Bilateral lung transplantation with donor aortic replacement normalizes pulmonary artery pressure to 22/7 mmHg.

n=1

Why the study?

A patent ductus arteriosus can result in pulmonary arterial hypertension requiring lung transplantation when refractory to medical management, and this report describes a novel surgical approach combining bilateral lung transplantation with simultaneous aortic replacement using a donor aorta to completely excise ductal tissue.

Key Points

To report a novel surgical strategy combining bilateral lung transplantation with simultaneous donor aortic replacement and aneurysm repair in an adult patient with treatment-refractory pulmonary arterial hypertension and patent ductus arteriosus.
Evaluated a 27-year-old female with pulmonary arterial hypertension and a 15 mm patent ductus arteriosus, with a baseline pulmonary vascular resistance of 33.8 Wood units and preserved left ventricular ejection fraction of 60%.
Performed bilateral lung transplantation at age 31 under cardiopulmonary bypass with complete excision of ductal tissue via proximal descending thoracic aorta resection (30 mm segment), replacement using a donor aortic graft, and reconstruction of a giant pulmonary artery aneurysm.
Surgical completion required an ischemic time of 12 hours and 45 minutes for the second lung graft.
The patient required venoarterial extracorporeal membrane oxygenation for 4 days followed by venovenous extracorporeal membrane oxygenation for 4 days for postoperative management.
The recipient was discharged 153 days postoperatively, remaining in good health at 16 months with 1-year computed tomography confirming reconstructed conduit stability and no aneurysmal recurrence.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

1 adult woman (age 31 at surgery, 100% female) in Japan with severe medication-refractory pulmonary arterial hypertension, a 15 mm patent ductus arteriosus, and an 80 mm giant pulmonary artery aneurysm, followed for 18 months post-transplantation.

I

Intervention

Bilateral lung transplantation (BLTx) under cardiopulmonary bypass with simultaneous replacement of approximately 30 mm of the proximal descending thoracic aorta using a donor aortic graft to completely excise ductal tissue, accompanied by resection and cylindrical conduit reconstruction of the aneurysmal pulmonary artery trunk using native pulmonary artery wall and central plication of the pulmonary valve cusps.

O

Outcome

Surgical feasibility, hemodynamic improvement, and clinical survival up to 16–18 months post-transplantation

Limitations

Single patient case report requiring further clinical experience to assess safety, reproducibility, and long-term outcomes
Potential long-term risks of using a donor aortic graft, including degeneration, dilatation, and graft infection requiring lifelong imaging surveillance
Prolonged graft ischemic times (10 h 18 min for the first lung and 12 h 45 min for the second lung) due to complex surgical sequence, contributing to grade 3 primary graft dysfunction
Prolonged graft ischemic times (10 h 18 min for the first lung and 12 h 45 min for the second lung) due to surgical complexity and sequence, which likely contributed to grade 3 primary graft dysfunction
Use of donor aorta carries potential long-term risks including degeneration, dilatation, and graft infection, necessitating lifelong imaging surveillance
Single case report requiring further clinical experience to assess safety, reproducibility, and long-term outcomes

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Implication

This first-in-literature case report demonstrates that bilateral lung transplantation combined with simultaneous descending thoracic aorta replacement using a donor aortic graft and native pulmonary artery trunk reconstruction is a feasible strategy for adult patients with severe PAH, a large PDA, and a giant pulmonary artery aneurysm.

Abstract

BACKGROUND: A patent ductus arteriosus (PDA) can result in pulmonary arterial hypertension (PAH) due to a left-to-right shunt. Lung transplantation (LTx) is indicated when PAH becomes refractory to medical management. We report a case of bilateral LTx (BLTx) with simultaneous aortic replacement using a donor aorta in an adult patient with PAH complicated by PDA. CASE PRESENTATION: A 27-year-old woman was referred for an LTx evaluation. At 1-year-old, she was diagnosed with a PDA. At the time of diagnosis, PDA closure was not indicated due to severe PAH, with a pulmonary vascular resistance of 33.8 Wood units. Despite receiving maximal medical therapy, her condition progressively deteriorated. She was placed on the transplant waitlist at age 27. Since left ventricular function was preserved (ejection fraction 60%) and no complex congenital heart disease was present, bilateral lung transplantation was chosen instead of heart-lung transplantation. Preoperative computed tomography revealed a giant pulmonary artery aneurysm (PAA). At 31 years of age, she underwent BLTx with simultaneous replacement of the proximal descending thoracic aorta using a donor aortic graft under cardiopulmonary bypass to enable complete excision of the ductal tissue. The giant PAA was also repaired during the same procedure. Postoperatively, she required venoarterial extracorporeal membrane oxygenation and was successfully weaned off by postoperative day 4. After an extended rehabilitation period, the patient was discharged 153 days postoperatively and remained in good health for 16 months following transplantation. CONCLUSIONS: To our knowledge, this is the first reported case of LTx with aortic replacement using a donor aortic graft for the management of PDA. We believe this combined procedure may represent a feasible surgical strategy for adult patients with PAH complicated by PDA and warrants further investigation in future cases.

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Cite This Study

Ishida et al. (2026) conducted a case report in Medication-refractory pulmonary arterial hypertension (PAH) complicated by patent ductus arteriosus (PDA) and giant pulmonary artery aneurysm (PAA) (n=1). Bilateral lung transplantation with simultaneous replacement of the proximal descending thoracic aorta using a donor aortic graft and pulmonary artery trunk reconstruction was evaluated on Postoperative survival, hemodynamic resolution of pulmonary hypertension, and graft stability. Bilateral lung transplantation with donor aortic replacement reduced pulmonary artery pressure from 125/80 to 22/7 mmHg, with discharge at day 153 and good health at 18 months.

synapsesocial.com/papers/6af30c3dd6330aecf130d293 https://doi.org/10.1186/s13019-025-03808-w

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Bilateral lung transplantation with simultaneous aortic replacement using donor aorta in a patient with pulmonary arterial hypertension and patent ductus arteriosus

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Bilateral lung transplantation with simultaneous aortic replacement using donor aorta in a patient with pulmonary arterial hypertension and patent ductus arteriosus

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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