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CARDIOVASCULAR ANESTHESIA

Differential Changes of Alveolar Gas Concentrations During Anesthetic Induction of a Patient with an Absent Right Pulmonary Artery

Yandong Jiang, MD, PhD^*, John C. Wain, MD, August W. Chang, MD^*, Warren M. Zapol, MD^*, and Zhongcong Xie, MD, PhD^*

From the *Department of Anesthesia and Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA.

Address correspondence and reprint requests to Zhongcong Xie, MD, PhD, Department of Anesthesia and Critical Care, 55 Fruit Street, CLN 309, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114. Address e-mail to zxie{at}partners.org.

A 38-yr-old man with congenital right pulmonary artery agenesis, whose right lung was perfused with collateral systemic arterial blood, presented for right pneumonectomy. Because of a likely difference in gas exchange between the two lungs, we sampled end-tidal gases from each lung individually, as well as from the common gas outlet of a double-lumen endobronchial tube. Our results indicated a higher end-tidal CO₂ from the left, normally perfused, lung than from the right, systemically perfused, lung. We also determined uptake of sevoflurane from each lung, demonstrating a more rapid uptake in the left lung than in the right. In conclusion, we report the rare case of unilateral pulmonary artery agenesis with systemic arterial collateralization and characterize the differences in gas exchange.