JAMES D. HARDY 
327 
Figure 3. — Bronchial suture line months following left lung replantation. There is no stenosis. 
Complications of the Bronchial Anastomosis 
Brief mention has been made of the hazard of 
vascular stenosis and thrombosis. Thrombosis 
of the pulmonary artery is uncommon and oc- 
clusion of the pulmonary veins is relatively in- 
frequent in the hands of experienced operators 
using the left atrial cuff technique. 
Bronchial complications v^^ill occur in a cer- 
tain number of animal experiments, and this 
problem has also been reported in several hu- 
man cases. Leakage at the bronchial anasto- 
mosis may result in infection, hemorrhage or 
pneumothorax. The bronchus and its mucosa 
are able to derive sufficient blood supply from 
the pulmonary artery, through a network of in- 
terconnecting small vessels in the bronchial 
mucosa. Thus, when the bronchial artery pres- 
sure is lowered by ligation of the bronchial ar- 
teries, pulmonary artery blood enters the mu- 
tual capillary bed to supply the bronchial 
mucosa, though with a less oxygenated blood 
than is normally the case. 
The integrity of the bronchial artery does not 
appear to be important for the blood supply of 
the main stem bronchus from the carina to the 
origin of the upper lobe bronchus in man. Ac- 
cordingly, it would appear advisable to leave the 
main stem bronchus of the recipient lung long, 
and to divide the bronchus of the donor lung 
fairly close to the origin of the upper lobe 
bronchus. Furthermore, excessive stripping or 
denuding of the bronchus of either donor or 
recipient should be avoided. Finally, we prefer 
to cover the bronchus with surrounding tissue 
when such tissue is available, though frequently 
it is not. 
Post-transplant bronchoscopy will frequently 
reveal a loss of bronchial mucosa at the suture 
line, but fortunately most animals do not exhibit 
