INTERPLEURAL COMMUNICATION — Interpleural communication can be a consequence of heart-lung transplantation (HLT) and sequential bilateral lung transplantation performed through bilateral anterolateral thoracotomies and transverse sternotomy (clam-shell) due to severing of the anterior pleural reflections. The interpleural communication allows air or fluid to move between the pleural spaces [53-56]. This phenomenon persists for more than two years after HLT [54,55] and is most likely permanent.