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Retrograde pulmonaryplegia for lung preservation in clinical transplantation: a new technique.

Pulmonary artery flush with modified Euro-Collins solution is currently used by many centers for lung preservation. Two limitations with this technique have been that pulmonary artery vasoconstriction necessitates pretreatment of the donor with a prostaglandin and that bronchial circulation, which supplies important nutrients to the intrapulmonary airways, has been ignored. Retrograde pulmonaryplegic solution delivered through the left atrium can perfuse the dual bronchial and pulmonary circulation; furthermore, pulmonary arterial constriction will not affect distribution and may actually enhance it. The technique was used in three successive patients who underwent heart-lung transplantation. Postoperative oxygenation remained excellent; no implantation response occurred, and all three patients were extubated in less than 24 hours. Retrograde pulmonaryplegia offers a simple technique of perfusing both the pulmonary and the bronchial circulation.