PURPOSE: To assess systolic pulmonary artery pressure, estimated by echocardiography, before and after unilateral pneumonectomy.
METHODS: After IRB approval we identified patients that underwent unilateral pneumonectomy at our institution from the year 2000 to 2010. We included patients that had Doppler echocardiogram performed after pneumonectomy. We reviewed the most recent study in each patient and the preoperative echocardiogram (within a year before surgery) when available.
RESULTS: Of a total of 222 patients that underwent unilateral pneumonectomy, 67 patients (age: 59 (±13) years, females: 25%) underwent echocardiography after a mean (±SD) of 24 (±29) months. Echocardiograms were performed while patients had SpO2 of ≥90% (O2: 0.7±1.2 L/m) for a variety of medical reasons such as chest pain and dyspnea. 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) %. Mean tricuspid jet velocity (TJV) (n=50) was 2.7 (±0.5) m/s. Of these patients, 21 (42%) had a TJV of ≥ 2.8 m/s. Only 2 patients (3%) had TJV of ≥ 3.4 m/s. Estimated right ventricular systolic pressure (RVSP) (n=51) was 37 (±12) mm Hg. Fifteen patients (29%) had a RVSP of ≥ 40 mm Hg. The difference between RVSP pre (n=18, 34 (±7) mm Hg) and post surgery (n=18, 39 (±11)) was not significant (p=0.2). None of the patients (n=40) had right ventricular (RV) dilation or dysfunction on preoperative echocardiograms. The postoperative echocardiogram (n=40) revealed RV dilation (≥ mild) and dysfunction (≥ mild) in 8 (20%, p=0.003) and 7 (18%, p=0.006) patients, respectively.
CONCLUSIONS: After pneumonectomy about 1 in five patients develops RV dilation and / or dysfunction that may not be reflected by the estimated right ventricular pressures.
CLINICAL IMPLICATIONS: Although no significant variation in estimated systolic pulmonary artery pressures occur after pneumonectomy, RV function may decline in some patients.
DISCLOSURE: The following authors have nothing to disclose: Gustavo Cumbo-Nacheli, Raed Dweik, Adriano Tonelli
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