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The Journal of Cardiovascular Surgery 2002 February;43(1):7-10

language: English

Lung impairment following cardiac surgery in patients with pulmonary hypertension

Ishikawa S., Ohtaki A., Takahashi T., Ohki S., Hasegawa Y., Yamagishi T., Oshima K., Hamada Y., Sakata K., Morishita Y.

From ­the Second Department of Surgery Gunma University School of Medicine, Maebashi, Japan


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Background. Postoperative res­pir­a­to­ry man­age­ment fol­low­ing car­diac sur­gery is some­times trou­ble­some in ­patients ­with pul­mo­nary hyper­ten­sion. We ret­ro­spec­tive­ly stud­ied ­the rela­tion­ship ­between ­the eti­ol­o­gy of pre­op­er­a­tive pul­mo­nary hyper­ten­sion ­and ­the post­op­er­a­tive ­decline of ­blood oxy­gen­a­tion capac­ity by focus­ing on ­the post­op­er­a­tive intra­vas­cu­lar ­fluid vol­ume.
Methods. Sixteen ­adult ­patients ­with an atri­al sep­tal ­defect (pre­load ­group) ­and 17 ­patients ­with sol­i­tary ­mitral ­valve dis­ease (after­load ­group) ­were stud­ied. The ­mean ­age of ­the ­patients in ­the pre­load ­and after­load ­group ­was 51 ­and 52 ­years ­old, respec­tive­ly.
Results. Preoperative pul­mo­nary-system­ic pres­sure ­ratio ­and pul­mo­nary ­artery resis­tance ­index ­were sig­nif­i­cant­ly high­er in ­the pre­load ­group ­than in ­the after­load ­group. The res­pir­a­to­ry ­index (RI) ­and ­the pul­mo­nary ­shunt ­ratio (Qs/Qt) meas­ured imme­di­ate­ly ­after ­the oper­a­tion ­was larg­er in ­the after­load ­group ­than in ­the pre­load ­group. Postoperative RI ­and Qs/Qt ­remained ­high ­until post­op­er­a­tive ­day 3 in ­both ­groups. In ­the pre­load ­group RI on post­op­er­a­tive ­day 1 ­had a ­reverse cor­re­la­tion ­with ­the cen­tral ­venous pres­sure (­CVP). Meanwhile, ­the RI in ­the after­load ­group on post­op­er­a­tive ­day 1 ­was slight­ly larg­er in ­patients ­with a ­high ­CVP ­and pul­mo­nary cap­il­lary ­wedged pres­sure. Similar rela­tion­ships ­were ­seen in ­the rela­tions ­between pul­mo­nary cap­il­lary ­wedged pres­sure ­and RI in ­the after­load ­group.
Conclusions. In con­clu­sion, a pre­op­er­a­tive pul­mo­nary vas­cu­lar ­change ­and a post­op­er­a­tive pre­cip­i­tous ­decrease of pul­mo­nary ­blood ­flow ­may ­have ­caused post­op­er­a­tive ­lung oxy­gen­a­tion impair­ment in ­the pre­load ­group. An extend­ed peri­od of extra­cor­po­real cir­cu­la­tion asso­ciat­ed ­with car­diac ­arrest ­and post­op­er­a­tive vol­ume over­load ­may ­have ­caused ­lung impair­ment in ­the after­load ­group. In ­aspect of post­op­er­a­tive man­age­ment, ­low ­CVP is ben­e­fi­cial to ­the ­patients in ­the after­load ­group, how­ev­er, hypo­vo­le­mia ­should be avoid­ed in ­patients of ­the pre­load ­group.

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