Respir Case Rep. 2020; 9(2): 66-69 | DOI: 10.5505/respircase.2020.81489

Kronik Böbrek Yetmezlikli Hastada Renal Transplantasyona Ýmkan Saðlayan Pulmoner Tromboendarterektomi: Olgu Sunumu

Halil Ýbrahim Yakar¹, Asiye Kanbay^2
1Tokat Gaziosmanpaþa Üniversitesi Týp Fakültesi Göðüs Hastalýklarý ABD
²Ýstanbul Medeniyet Üniversitesi Týp Fakültesi Göðüs Hastalýklarý ABD

Pulmoner endarterektomi (PEA), kronik tromboembolik pulmoner hipertansiyon (KTEPH) hastalarýnda cerrahi tedavi yöntemi olarak kullanýlmaktadýr. Diðer yandan mortalite ve morbiditesi yüksek bir cerrahidir. Burada ileri derece pulmoner hipertansiyonu (PH) bulunan, kronik böbrek yetmezliði (KBY) nedenli hemodialize giren ve bu nedenle yüksek riskle PEA yapýlan bir olgu sunuldu. Yirmi iki yaþýnda erkek hasta, bilateral hidronefroza baðlý KBY nedeni ile 5 yýldýr haftada 3 gün hemodialize girmekteydi. Giderek artan nefes darlýðý nedeniyle hastaneye baþvurdu. Klinik ve radyolojik olarak KTEPH tanýsý konuldu. Takiplerinde medikal tedaviye raðmen yeterli klinik yanýt alýnamamasý nedeniyle hastaya yüksek riske raðmen pulmoner endarterektomi planlandý. Göðüs cerrahisi tarafýndan bilateral PEA operasyonu uygulandý. Hastanýn kontrol ekokardiografisinde sPAP: 105 mmHg’dan 35 mmHg’ a geriledi. Cerrahi sonrasý takiplerinde hastanýn istirahat dispnesi kayboldu, eforla dispne þikayeti belirgin azaldý ve fonksiyonel kapasitesi arttý. Operasyon öncesi pulmoner hipertansiyon nedeniyle hastada renal transplantasyon kontrendike iken, postoperatif þikayetlerinin gerilemesi ve pulmoner arter basýncý düþmesi nedeniyle hastaya transplantasyon imkaný oluþtu. Bu olgu sunumunda, baþarýlý bir PEA geçirdikten sonra böbrek nakli imkaný oluþan bir KTEPH hastasý sunuldu.

Anahtar Kelimeler: Kronik Tromboembolik Pulmoner Hipertansiyon, Kronik Böbrek Yetmezliði, Pulmoner Endarterektomi

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Pulmonary Thromboendarterectomy Enabling Renal Transplantation in Patient of Chronic Kidney Disease: A Case Report

Halil Ýbrahim Yakar¹, Asiye Kanbay^2
1Tokat Gaziosmanpasa University, Faculty of Medicine, Department of Chest Disease
²Istanbul Medeniyet University, Faculty of Medicine, Department of Chest Disease

Pulmonary endarterectomy (PEA) is a surgical treatment approach for the treatment of patients with chronic thromboembolic pulmonary hypertension (CTEPH). The surgery is considered high risk in terms of mortality and morbidity. We present here a patient at high operative risk due to severe pulmonary hypertension (PH) and chronic renal failure (CKD). The 22-year-old male patient was undergoing hemodialysis treatment for three years due to bilateral hydronephrosis-induced CKD, and was admitted to the hospital with increasing dyspnea. The diagnosis of CTEPH was made clinically and radiologically. During the follow-up period, an endarterectomy was planned, although the patient was considered high risk due to insufficient clinical response, despite medical therapy. Bilateral PEA was applied by thoracic surgery team. sPAP decreased from 105 to 35 mmHg on echocardiography, and dyspnea was improved and functional capacity recovered after the PEA surgery. A renal transplantation was contraindicated in the preoperative period due to severe pulmonary arterial hypertension. PEA surgery was enabled to patient kidney transplantation due to an improvement in pulmonary functions and pulmonary artery pressure. We present here a case of CTEPH who had a chance of kidney transplantation after undergoing successful PEA surgery.

Keywords: Chronic Thromboembolic Pulmonary Hypertension, Chronic Renal Failure, Pulmonary Endarterectomy

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