Cardiac Arrhythmias following Pneumonectomy

Bailey, C. Cabell; Betts, Reeve H.

doi:10.1097/00000542-194403000-00025

Cited by 4 publications

(5 citation statements)

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“…The problem of postoperative arrhythmias after lung resections was first mentioned by BAILEY and BETTS [89] and CURRENS et al [90] in 1943, and has been described by various authors since [63,[90][91][92][93]. Prophylactic digitalization was advocated by many authors in the 1960s and 1970s [94][95][96].…”

Section: Cardiac Riskmentioning

confidence: 99%

Functional evaluation of the lung resection candidate

Bolliger¹,

Perruchoud²

1998

Eur Respir J

163

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Advances in operative technique and perioperative care have considerably reduced surgical morbidity and mortality after pulmonary resections. Various single and combined parameters of functional operability have been proposed to assess the surgical risk. Pulmonary function tests adequately assess the pulmonary risk, and baseline or stress electrocardiography, echocardiography and nuclear cardiac studies assess the cardiac risk.Patients with normal or only slightly impaired pulmonary function (forced expiratory volume in one second (FEV1) and transfer factor of the lung for carbon monoxide (TL,CO) ≥80% of predicted) and no cardiovascular risk factors can undergo pulmonary resections up to a pneumonectomy without further investigation. For others, exercise testing, pulmonary split-function studies, or a combination of these two methods are recommended. Exercise testing, most frequently performed as a symptom-limited test with the measurement of maximal oxygen uptake (V 'O 2 ,max), assesses both the pulmonary and cardiovascular reserves. A V'O 2 ,max of <10 mL·kg -1 ·min -1 is generally considered prohibitive for any resection, a value of >20 mL·kg -1 ·min -1 or >75% of predicted normal, safe for major resections. Split-function studies are radionuclide-based estimations of the predicted postoperative (ppo) values of various parameters. The currently used ppo-parameters are FEV1-ppo, TL,CO-ppo and, most recently, V'O 2 ,max-ppo. Suggested cutoff values for safe resection are: for FEV1-ppo and TL,CO-ppo ≥40% pred; and for V 'O 2 ,max ≥35% pred, combined with an absolute value of ≥10 mL·kg -1 ·min -1 . The lowest acceptable ppo-values will still have to be established by additional prospective studies.In the long-term, resections involving not more than one lobe usually lead to an early functional deficit followed by later recovery. The permanent functional loss in pulmonary function is small (≤10%) and exercise capacity is only slightly reduced or not at all. Pneumonectomy, on the other hand, leads to an early permanent loss of about 33% in pulmonary function and 20% in exercise capacity. Thus, pulmonary function tests alone overestimate the functional loss after lung resection. Eur Respir J 1998; 11: 198-212 The dramatic increase in the incidence of bronchogenic carcinoma has made this disease the most frequent malignancy worldwide. In industrialized nations, the majority of lung resection candidates suffer from bronchogenic carcinoma, whereas only some decades ago benign conditions, such as destroyed lung parenchyma after tuberculosis, had to be removed. The prognosis of bronchogenic carcinoma remains sombre as about 75-85% are inoperable at the time of diagnosis [1], and despite recent advances in chemo-and radiotherapy regimens, surgical resection remains the only curative form of treatment [2].Depending on their extent, pulmonary resections lead to permanent loss of pulmonary function. In healthy people, resections up to a pneumonectomy are tolerated remarkably well. Lung cancer patients, however, are...

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Section: Cardiac Riskmentioning

confidence: 99%

Functional evaluation of the lung resection candidate

Bolliger¹,

Perruchoud²

1998

Eur Respir J

163

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“…No instance of arrhythmia unconfirmed by electrocardiogram is included, although a number of these occurred during the period covered by this study. Hence, we cannot give the exact incidence of supraventricular tachycardia following operations done at Memorial Center, but it would appear to be well under 1 per cent, since approximately 28,000 operations were performed during this five and two-thirds year period. Thirty-one of the patients were males; 19 were female.…”

Section: Observations Incidencementioning

confidence: 90%

“…The electrocardiograms taken at Memorial Center between Jan. 1,1946 and Sept. 1, 1951, were excluded. Ventricular tachycardia was not encountered.…”

Section: Methodsmentioning

confidence: 99%

Supraventricular Tachycardia Complicating Surgical Procedures

1953

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Persistent postoperative supraventricular tachycardia, despite adequate therapy, is a bad prognostic sign, and cardiac failure due to, or associated with, arrhythmia responds poorly to treatment. Of the 12 patients (24 per cent) resistent to therapy, eight developed congestive heart failure, with five dying as a result. The preoperative, intraoperative and postoperative factors contributing to the causes of this complication are reviewed, and the therapy, course and end results are discussed.T HE OCCURRENCE of supraventricular tachycardia during and following surgical procedures is a relatively infrequent but dangerous complication. Several case reports emphasizing its importance following chest surgery have been published,1-3 but little is known of the incidence and behavior of such arrhythmias in other types of surgery.4 ,1,1 We have studied these arrhythmias as they developed during the operative and postoperative course of 50 patients (54 instances of arrhythmia) with particular reference to: (1) underlying and precipitating causes; (2) course of the arrhythmia, including its response to treatment; and (3) the influence of the complication upon the surgical outcome and subsequent cardiac status.

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“…The close correlation between thoracic surgical procedures and the onset of postoperative supra-ventricular arrhythmias was documented as early as the nineteen forties [1,2]. Atrial fibrillation (AF) accounts for most of such postoperative supraventricular arrhythmias and its occurrence has been reported to add health care costs and prolong hospital stay [3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%