Unilateral Pulmonary Edema during Aortic Valve Replacement through Median Sternotomy

Unilateral pulmonary edema (UPE) has been reported as a re-expansion pulmonary edema that occurs following rapid re-expansion of a collapsed lung in a patient with pneumothorax or large volume of pleural fluid. Recently, UPE after minimally invasive cardiac surgery through right-sided thoracotomy has received considerable attention because of its increasing morbidity and mortality. However, development of UPE in patients undergoing cardiac surgery through median sternotomy has not generally been recognized. Herein, we present our experience of UPE of the right lung after aortic valve replacement through median sternotomy. UPE may reflect ventilation-induced lung injury in concomitant systemic inflammation by cardiopulmonary bypass. Heterogeneity of lung collapse and wide pleural opening, which induced lung overdistension during recruitement, were considered to be associated with the occurrence of UPE in this case. Preventive measures should be considered for patients with multiple risk factors, and a meticulous recruitment maneuver is required for lung re-expansion during cardiac surgery.