
==== Front
Anesthesiology
Anesthesiology
ALN
Anesthesiology
0003-3022
1528-1175
Lippincott Williams & Wilkins Hagerstown, MD

38885116
ALN-D-24-00412
00022
10.1097/ALN.0000000000005057
3
Education: Images in Anesthesiology
Lung Isolation of Patients with Lung Transposition
https://orcid.org/0000-0003-1642-3764
Zhao Dan M.M. yanqingzd@126.com
1
Yang Tianqi M.M. 857587071@qq.com
2
Yao Guang M.M. yaoguang1981@126.com
3
Sun Chao M.D. sunchao0101@126.com
4
1 Department of Anesthesiology, Binzhou Medical University Hospital, Binzhou, China.
2 Department of Anesthesiology, Binzhou Medical University Hospital, Binzhou, China.
3 Department of Anesthesiology, Binzhou Medical University Hospital, Binzhou, China.
4 Department of Anesthesiology, Binzhou Medical University Hospital, Binzhou, China.
Address correspondence to Dr. Sun: sunchao0101@126.com
17 6 2024
10 2024
141 4 750751
Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc., on behalf of the American Society of Anesthesiologists.
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

OPEN-ACCESSTRUE
SDCT
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pmcA 51-year-old female patient with mirror-image dextrocardia and lung transposition (three lobes in the left lung and two lobes in the right) underwent thoracoscopic resection of an anterior mediastinal mass and partial right lung. Preoperative chest computed tomography revealed the take-off of the upper lobe of the left lung near the tracheal carina (fig. 1A). Flexible bronchoscopy confirmed intraoperatively that the left lung divided into three lobes (fig. 1B and Supplemental Digital Content video 1, https://links.lww.com/ALN/D566). Considering that the distal segment of the left-sided double-lumen tube may block the take-off of the upper lobe of the left lung and potentially cause severe hypoxemia during one-lung ventilation,1,2 the patient’s lung isolation was achieved with a right-sided double-lumen tube (35 French) and intended surgery was completed uneventfully.

Fig. 1. Mirror-image dextrocardia with lung transposition. (A) Preoperative chest computed tomography confirmed dextrocardia as well as the level of the left upper lobe bronchus. (B) Intraoperative flexible bronchoscopy confirmed three lobar bronchus in the left lung.

Mirror-image dextrocardia, a rare congenital heart condition, often accompanies visceral transposition, such as lung transposition, presenting challenges in lung isolation. Careful consideration and planning are necessary for such a patient in thoracic surgery. A right-sided double-lumen tube is preferable for procedures not involving the right bronchus. If surgery involves the right bronchus, a right-sided double-lumen tube, together with a bronchial blocker, may be chosen to achieve lung isolation. However, intermittently pausing respiration and adjusting the double-lumen tube or blocker is vital for achieving and maintaining adequate lung isolation. Alternatively, a left-sided double-lumen tube could be considered, although it risks poor ventilation of the upper lobe of the left lung.1,2 If this is not possible, one can also insert the bronchial lumen of the right-sided double-lumen tube into the left main bronchus to achieve better ventilation of the upper lobe of the left lung.3

In summary, lung isolation in thoracic surgery for patients with lung transposition demands meticulous planning and strategy from the anesthesia care team.

Competing Interests

The authors declare no competing interests.

Supplemental Digital Content

Video 1. Intraoperative flexible bronchoscopy confirmed three lobar bronchus in the left lung, https://links.lww.com/ALN/D566

Supplementary Material

Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).

The article processing charge was funded by the authors.
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References

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