Postpneumonectomy Compression of the Mitral Annulus: Rare Vascular Complication in Sportive Patient

Abstract EN

Numerous postpneumonectomy complications exist.

We present a rare clinical case of postpneumonectomy exertional dyspnea revealing compression of the mitral annulus by the descending aorta.

The patient was 42-year-old former smoker with pulmonary emphysema.

He has been operated on, in 2012 (i.e., right pneumonectomy).

Before the surgery, the patient was a recreational runner.

However, after some months, it was difficult for the patient to resume running.

Cardiopulmonary exercise testing indicated moderate exercise intolerance with important oxygen desaturation.

More interestingly, a decrease of low oxygen pulse was noticed from the first ventilatory threshold with no electrical modification on the electrocardiogram.

This decrease was indicative of a decline in stroke volume.

The thoracic scan revealed a right pneumonectomy pocket with a liquid abnormal content.

Moreover, the mediastinum had shifted toward the pneumonectomy space and the left lung was distended and emphysematous.

Echocardiography revealed a major change in the mediastinal anatomy.

The mitral annulus was observed to be compressed by the rear wall of the descending aorta.

The diagnosis of postpneumonectomy syndrome or platypnea-orthodeoxia syndrome was ruled out in this patient.

Mitral annular compression by the descending aorta is rare complication, which must be researched in patients with postpneumonectomy exertional dyspnea.