Ryo Miyoshi, MD, Toyofumi F

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Presentation transcript:

Pulmonary Function and Exercise Capacity in Patients With Flat Chests After Lung Transplantation Ryo Miyoshi, MD, Toyofumi F. Chen-Yoshikawa, MD, PhD, Akihiro Takahagi, MD, Yohei Oshima, RPT, MS, Kyoko Hijiya, MD, Hideki Motoyama, MD, PhD, Akihiro Aoyama, MD, PhD, Hiroshi Date, MD, PhD The Annals of Thoracic Surgery Volume 104, Issue 5, Pages 1695-1701 (November 2017) DOI: 10.1016/j.athoracsur.2017.06.023 Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 The diagnostic criteria for flat chest are based on the definition of straight back syndrome by DeLeon and associates [16]. On chest computed tomography, the anteroposterior diameter “a” (left) was defined as the distance from the anterior border of T8 to the posterior border of the sternum. The lateral diameter “b” (right) was defined as the transverse distance at the level of the diaphragm. Flat chest was diagnosed when a/b was 1:3 or less. The Annals of Thoracic Surgery 2017 104, 1695-1701DOI: (10.1016/j.athoracsur.2017.06.023) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Typical appearance of chest computed tomography (CT) before and after lung transplantation. (A) Preoperative chest CT image from an 18-year-old man with a flat chest who had lung injury after hematopoietic stem cell transplantation. (B) Chest CT image from the same patient 1 year after lung transplantation, showing a significant increase in the anteroposterior thoracic diameter. (C) Preoperative chest CT image from a 50-year-old woman with a normal chest who had interstitial lung disease. (D) Chest CT image from the same patient 1 year after lung transplantation. The Annals of Thoracic Surgery 2017 104, 1695-1701DOI: (10.1016/j.athoracsur.2017.06.023) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Typical appearance of three-dimensional computed tomography (3D-CT) before (left panels) and after (right panels) lung transplantation. (A) Preoperative 3D-CT image from an 18-year-old man with a flat chest who had lung injury after hematopoietic stem cell transplantation. (B) Three-dimensional CT image from the same patient 1 year after lung transplantation, showing a significant improvement in flat chest shape severity. (C) Preoperative 3D-CT image from a 54-year-old man with a normal chest who had interstitial lung disease. (D) Three-dimensional CT image from the same patient 1 year after lung transplantation. The Annals of Thoracic Surgery 2017 104, 1695-1701DOI: (10.1016/j.athoracsur.2017.06.023) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Donor graft forced vital capacity (FVC) and 6-minute walk distance in the flat chest group and normal chest group. (A) The ratio of the donor graft FVC to the preoperatively estimated FVC in the flat chest group (solid line) was significantly lower than that in the normal chest group (dashed line) 1 year after lung transplantation (p = 0.002). (B) There were no significant differences in 6-minute walk distances between the flat chest group (solid line) and normal chest group (dashed line) 1 year after lung transplantation (p = 0.88). The Annals of Thoracic Surgery 2017 104, 1695-1701DOI: (10.1016/j.athoracsur.2017.06.023) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Changes in the thoracic anteroposterior diameter to transverse diameter ratio in the flat chest group (solid line) and normal chest group (dashed line). A significant increase was observed in the thoracic anteroposterior diameter to transverse diameter ratio before and 1 year after lung transplantation in the flat chest group (28.5% ± 5.5% and 32.0% ± 7.0%, respectively; p = 0.02). Alternatively, there were no significant differences in this ratio before and 1 year after lung transplantation in the normal chest group (40.6% ± 5.1% and 38.7% ± 7.3%, respectively; p = 0.90). (NS = not significant.) The Annals of Thoracic Surgery 2017 104, 1695-1701DOI: (10.1016/j.athoracsur.2017.06.023) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions