Impact of Major Pulmonary Resections on Right Ventricular Function: Early Postoperative Changes

Abstract

There is right ventricular dysfunction early after major pulmonary resection caused by increased right ventricular afterload. This dysfunction is more present in pneumonectomy than in lobectomy. Heart rate, mean pulmonary artery pressure, pulmonary capillary wedge pressure, pulmonary vascular resistance, right ventricular ejection fraction, and right ventricular end diastolic volume index are significantly affected by pulmonary resection.

Accelerated right heart failure due to lung resection in the setting of chronic respiratory failure

“…Lung resection decreases the vascular bed available for right ventricular output, which decreases pulmonary vascular capacitance and increases resistance, increas-ing the afterload of the right ventricle [ 4 , 5 ]. As mentioned above, the right heart cannot withstand such increased strain, and subsequent right ventricle dilation with decreased ejection fraction follows [6] . While the expansion of alveolar-capillary reserves from the remaining lung tissue should offset this change, this may be problematic in pre-existing lung disease due to an already present ventilation-perfusion mismatch and intrapulmonary shunting [7] .…”

A Case Report of Right Pneumonectomy with a Focus on the Right Ventricular Function and Hemodynamic Management

“…The RV damage may also be influenced by the intraoperatively selected mechanical breathing mode. In the presence of underlying RV dysfunction, the severity of the dysfunction may be greater [2] [5] [6].…”

“…The anesthesiologist has a special set of difficulties during a pneumonectomy. The total surgical mortality is still high and varies from 5% to 13% [1], notably for the right pneumonectomy, within the first 30 days following the procedure [2]. Each patient should have their estimated respiratory, lung parenchymal, and cardiovascular reserves evaluated prior to sur-gery [1].…”

Pulmonary hemodynamics and lung surgery: a narrative review

“…The patients who underwent pneumonectomy had a higher degree of right ventricular dilation, a higher incidence of post-operative arrhythmias, and a greater reduction in right ventricular ejection fraction than lobectomy patients. This suggests that the amount of parenchymal resection may be proportional to the subsequent increase in right ventricular afterload and degree of right ventricular systolic dysfunction (36).…”