Bronchiectasis and pulmonary fibrosis of the surrounding parenchyma can result from recurrent infection and inflammation. A portion of these patients can present with complete destruction of their lung parenchyma, retraction of the chest cavity and concurrent mediastinal shift. In some cases, lung transplantation is the final option once the reduction of lung capacity becomes clinically detrimental. Concerns with mediastinal shift and chest wall retraction may limit the indication of a double lung transplant in these patients. We report the outcomes as well as preoperative and operative management in two patients with significant lung volume reduction and mediastinal shift due to bronchiectasis of the right lung. Both patients underwent sequential double lung transplantation due to lung failure.

We report a first case with the use of extracorporeal carbon dioxide removal system as a bridge to re-do lung transplant in complete situs inversus patient. A 29-year-old female with Kartagener syndrome and complete situs inversus underwent a double lung transplant for end stage lung disease. Within one year after transplant the patient had primarily hypercapnic respiratory failure with radiographic signs of chronic lung allograft dysfunction. To optimize her nutritional status and muscle strength before re-do lung transplantation, we decided to bridge her with an extracorporeal carbon dioxide removal system due to anatomical difficulty. She was listed and underwent an uneventful re-do double lung transplant with cardiopulmonary support.

Extracorporeal membrane oxygenation (ECMO) is a technology that has allowed for further cardiopulmonary support in the setting of respiratory failure refractory to mechanical ventilation. While it has evolved since its first description, one area of improvement continues to be its implementation. With advancements in cannulation techniques, in recent years, there has been a plethora of new cannulas that has been introduced to the market. For urgent venous-venous cannulation, the right internal jugular vein along with either femoral veins remain the most utilized strategy due to minimal need for imaging support. This allows for safe bedside cannulation. However, as the number of days of ECMO support continue to increase bridging patients to an easier to ambulate and more comfortable cannulation strategy is preferred. Therefore, we describe a method for bridging right jugular-femoral cannulation to left subclavian placement of the CrescentTM Dual Lumen Catheter without interrupting ECMO support.