To evaluate the value of transesophageal echocardiography (TEE) in monitoring pulmonary vascular anastomosis and changes of right ventricular function in lung transplantation.

This study enrolled nine patients receiving allogeneic lung transplantation because of end stage lung disease at the First Affiliated Hospital of Xi′an Jiaotong University from September 2018 to July 2019. Intraoperative TEE monitoring indicators included the flow velocities of the left upper pulmonary vein, left lower pulmonary vein, right upper pulmonary vein, right lower pulmonary vein, left pulmonary artery, and right pulmonary artery before opening the chest and after opening the anastomosis; and diameters of the right ventricular base and mid-septum, tricuspid annular plane systolic excursion (TAPSE), fractional area change of the right ventricle (RVFAC), and left ventricular total ejection fraction (LVEF) before opening the chest and at single lung ventilation, pulmonary artery clipping, and anastomosis opening.

Compared with the values before opening the chest, the flow velocities of the pulmonary arteries and veins were increased after anastomosis (P≤0.005), but there was no significant stenosis; the diameters of the right ventricular base and mid-septum showed no significant change after single lung ventilation, but were significantly increased after clamping the pulmonary artery (P<0.005). The diameters of the right ventricular base and mid-septum were retracting after opening the anastomosis, and significantly smaller than those at the stage of clamping the pulmonary artery (P<0.001) and before opening the chest (P<0.05). The TAPSE and RVFAC of two patients were lower than the normal range before surgery. After the anastomotic opening, the TAPSE and RVFAC were not improved. Nine patients had no significant change in TAPSE after single-lung ventilation. The TAPSE at the stage of clamping the pulmonary artery was significantly lower than that before opening the chest (P<0.005), but restored to the preoperative level after opening the anastomosis. In this study, 9 patients had no significant change in RVFAC after single-lung ventilation. The RVFAC was significantly decreased after clamping the pulmonary artery (P<0.005), and there was an increase after anastomotic opening, although it was still lower than that before opening the chest (P<0.05).

In allogeneic lung transplantation, TEE can not only assess the anastomotic stenosis of the pulmonary artery and vein after anastomosis, but also monitor the changes of right ventricular function, which is of great significance for monitoring the surgical process and postoperative management.