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

## TL;DR

A patient with severe lung disease and a heart defect underwent a rare combined surgery involving lung and aorta replacement, which may offer a new treatment approach.

## Contribution

This is the first reported case of lung transplantation with donor aortic graft replacement for managing pulmonary hypertension and patent ductus arteriosus.

## Key findings

- The patient successfully underwent bilateral lung and aortic replacement using a donor aorta.
- Postoperative recovery was achieved after extracorporeal membrane oxygenation support.
- The patient remained in good health for 16 months after the combined procedure.

## Abstract

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.

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.

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.