Long-term Doppler echocardiographic evaluation of the right heart after major lung resections

Abstract

Objective: The effects of major lung resections on cardiac function in the medium and long term have not been thoroughly evaluated. We have studied right heart function with serial Doppler echocardiography in patients undergoing lobectomy and pneumonectomy during 4 years of follow-up after surgery. Methods: Thirty-six patients undergoing lobectomy and 15 receiving pneumonectomy were evaluated with one-and two-dimensional Doppler standard transthoracic echocardiography before surgery and 1 week, 3 months, 6 months, 1 year, and 4 years postoperatively. We have studied the right midventricular diastolic diameter (RVDD), the right ventricle free wall thickness, the tricuspid valve insufficiency (TVI) and regurgitation jet (TRJ), and the pulmonary artery systolic pressure (PASP). Results: None of the patients died within the first postoperative year. After lobectomy there were no significant modifications of any variable at any time. RVDD progressively increased after pneumonectomy (26.5 AE 2.2 mm preoperatively vs 34.3 AE 7.6 at 4 years; p < 0.001). Four years after surgery all patients undergoing pneumonectomy had moderate TVI while only 55% of patients receiving lobectomy showed it (low grade in 50% and moderate in 5%). In this group of patients PASP increased from 26.1 AE 2.6 mmHg preoperatively to 34.3 AE 7.6 mmHg at 4 years ( p < 0.00001). Conclusions: Right ventricle modifications are clearly evident after pneumonectomy and even if they do not show a clear clinical impact they should not be neglected. #

Echocardiographic Evaluation of Right Ventricular Function in the Immediate Postoperative Period after Major Pulmonary Resections: A Prospective Observational Study

“…Similar to other studies, RV function significantly decreases on the POD 2, which gradually improved by the 7th POD and stabilized thereafter. 1,12,13 However, LV function did not differ over the said time period except a slight fall in MV lateral Ś on POD 2 ( Table 2).…”

“…Standard echocardiographic techniques have been used to assess the effects of pulmonary surgery on RV function. 1,2 Right heart catheterization has been used for the evaluation of right heart function after pneumonectomy with its own limitations and risks. 3,4 Significant postoperative RV dysfunction manifests on the 2nd POD.…”

Anaesthetic Management of The Patient Undergoing Cardiopulmonary Bypass Graft Surgery After Pneumonectomy

“…Although respiratory and cardiovascular systems adapt to the patient's present condition who had only one lung, compensatory mechanisms eventually result in restrictive lung disease (3,4). In one study which followed patients for up to four years after pneumonectomy, right ventricular (RV) morphology and func-tion slowly altered to result in RV overload, moderate tricuspid valve insufficiency, and high pulmonary artery pressures (4) . In our patient, cardiac function and valvular tissues were found to be normal on transthoracic echocardiography.…”

“…After pneumonectomy, the respiratory and cardiovascular systems adapt to the absence of one lung and various compensatory mechanisms which result in the development of restrictive lung disease in the remaining lung (3) . Right ventricular (RV) morphology also adapts itself to the absence of one lung, and with time, moderate tricuspid valve insufficiency and significantly higher pulmonary artery systolic pres-sures are seen (4,5) . Normal anatomic relationships -of the thorax are altered after pneumonectomymediastinal structures and thoracic organs shift toward the empty hemithorax, and fill this area as a compensatory mechanism.…”

Suppression of Right Ventricular Hypertrophy After Extensive Pulmonary Resection in Rats by Granulocyte Colony-Stimulating Factor

“…If a UPAO test predicts postoperative pulmonary hypertension, either limited resection is performed or surgery is abandoned altogether. When assessed using Doppler echography in the perioperative period or a long time after pulmonary resection [13][14][15], postoperative pulmonary artery systolic pressure for pneumonectomy was significantly higher than that for lobectomy, and at 6 mo and 4 y after surgery, right ventricular enlargement was also evident. Since the right ventricular function as a reservoir for increased afterload following pulmonary resection, even if the right ventricle can compensate at rest, exercise-related increases in pulmonary blood circulation above the compensatory capacity can cause pulmonary arterial pressure to increase and result in right heart failure [16].…”