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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2013 April;26(2):73-8
Effect of pneumonectomy on pulmonary artery pressure and right ventricular function
Cumbo-Nacheli G., Tonelli A., Dweik R. A.
Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
Aim: Little is known about the expected changes in pulmonary pressure and right ventricular (RV) function after pneumonectomy. The aim of the present study is to assess right ventricular systolic pressure and RV function after pneumonectomy.
Methods: After IRB approval, we identified patients that underwent unilateral total pneumonectomy at our institution from January 2000 to January 2010. We included patients that had Doppler echocardiograms performed after pneumonectomy. We reviewed the most recent study and compared the results with the preoperative echocardiograms when available.
Results: A total of 67 patients (age: 59 [SD:±13] years, men: 75%) had an echocardiography performed after a mean of 24 (±29) months after unilateral total pneumonectomy. Intrathoracic malignancy accounted for 98% of pneumonectomies. Left and right pneumonectomy was performed in 54% and 46% of the patients, respectively. Postoperatively, mean left ventricular ejection fraction was 55 (±9)%. In 52 patients we were able to estimate RSVP, and of them 15 (29.4%) had pressures of ≥ 40 mmHg. The difference between RVSP pre and post surgery was not significant (33±7 vs. 37±12 mm Hg, P=0.21). Tricuspid jet velocity (TJV) was measured in 50 patients. Of them, 21 (42%) had a TJV of ≥ 2.8 m/s and 2 (3%) patients had a TJV of ≥ 3.4 m/s. There were no patients with preoperative RV dysfunction; whereas 11 patients developed various degrees of RV dysfunction postoperatively. Patients who underwent right pneumonectomy had lower estimated RVSP than patients that had left lung resection (32 mm Hg versus 41 mm Hg, respectively; P=0.004).
Conclusion: Although no significant variation in estimated systolic pulmonary artery pressures were detected by echocardiography, RV function declined in some patients after pneumonectomy. Left pneumonectomy was associated with higher RVSP than right lung resections.