Value of perioperative Doppler echocardiography in patients undergoing major lung resection

Amar, David; Burt, Michael; Roistacher, Nancy; Reinsel, Ruth A.; Ginsberg, Robert J.; Wilson, Roger S.

doi:10.1016/0003-4975(95)00939-6

Cited by 62 publications

(56 citation statements)

References 15 publications

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“…Amar et al found a small increase in pulmonary artery systolic pressure (PASP) by using standard echocardiography following pulmonary resections in their series. Additionally, pneumonectomy patients had significantly higher PASP than the lobectomy patients in their study (8). We also measured lower tricuspid annular S' wave velocities in pneumonectomy patients than in lobectomy patients, which again proved the theory of higher after-load on the RV following larger resections.…”

Section: Discussionsupporting

confidence: 59%

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Tissue Doppler evaluation of the right ventricle in major pulmonary resections

Kumbasar¹,

Kavukcu²,

Özdemır³

et al. 2013

Turk J Med Sci

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To analyze the consequences of major pulmonary resections on right ventricle (RV) function by using the tissue Doppler imaging (TDI) technique.Materials and methods: Twenty patients (16 males and 4 females) who received pulmonary resection for primary non-small cell lung cancer underwent echocardiographic examinations before surgery on the 2nd and 7th postoperative days. Results:Tricuspid E wave significantly decreased from the postoperative 2nd day to the 7th day (45.93 ± 8.0 to 35.77 ± 7.4 cm/s; P = 0.02). On the postoperative 2nd and 7th days, tricuspid A wave values (58.27 ± 9.6 and 58.94 ± 8.4 cm/s) were significantly higher compared to preoperative values (45.71 ± 12.2 cm/s; P = 0.02 for both). The S' wave measured at the basal segment of the right ventricle markedly decreased on the postoperative 2nd day (12.35 ± 2.2 to 10.15 ± 3.2 cm/s; P = 0.03). Tricuspid annular S' wave velocity of patients who underwent pneumonectomy was lower than in patients who underwent lobectomy (10.65 ± 2.4 versus 14.42 ± 3.3 cm/s; P = 0.04). Conclusion:In the early postoperative period, significant dilatation and dysfunction of the RV is caused by pulmonary resection. Early detection of this deterioration by means of this noninvasive technique could make swift interventional therapy possible, which is an important step towards avoiding future right heart failure.

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Section: Discussionsupporting

confidence: 59%

“…The extent of lung parenchyma resection is also critical in RV functions (4,8,15). Amar et al found a small increase in pulmonary artery systolic pressure (PASP) by using standard echocardiography following pulmonary resections in their series.…”

Section: Discussionmentioning

confidence: 99%

Tissue Doppler evaluation of the right ventricle in major pulmonary resections

Kumbasar¹,

Kavukcu²,

Özdemır³

et al. 2013

Turk J Med Sci

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“…Doppler echocardiography has progressively gained popularity in the last two decades to evaluate right ventricle (RV) morphology and function; this technique allows also us to estimate pulmonary artery systolic pressure (PASP) [13,14]. It has also been validated in patients with chronic obstructive pulmonary disease (COPD) [15][16][17][18][19] and successfully employed to study early-and medium-term effects of pneumonectomy and lobectomy on RV function [8,12]. However, no data are currently available on the late effects of major lung resections on the right heart.…”

Section: Introductionmentioning

confidence: 99%

“…Right ventricular morphology and function have gained increasing clinical importance [1][2][3][4][5], but only limited information on adaptation after major lung resections has been reported, focusing on the immediate postoperative period and the first 6 months after surgery [6][7][8][9][10][11][12]. Invasive hemodynamic measurements have been performed before, during, and after pulmonary resections; however, catheterization is certainly not comfortable for the patient and may carry complications.…”

Section: Introductionmentioning

confidence: 99%

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

Venuta

Sciomer

Andreetti

et al. 2007

European Journal of Cardio-Thoracic Surgery

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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. #

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“…Indeed, excess collagen deposition in the extracellular matrix coupled with a progressive loss of cardiac myocytes by apoptotic cell death are hallmarks of the senescent heart that have been incriminated in the pathogenesis of ventricular dysfunction and atrial fibrillation [32]. Moreover, the pulmonary circulatory system becomes less compliant after extended parenchymal lung resection, resulting in increased right ventricular afterload [33]. However, autonomic nerve injuries occur inevitably when surgical dissection involves the hilar mediastinal structures [34].…”

Section: Discussionmentioning

confidence: 99%

Impact of aerobic exercise capacity and procedure-related factors in lung cancer surgery

Licker¹,

Schnyder²,

Frey³

et al. 2010

European Respiratory Journal

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Over the past decades, major progress in patient selection, surgical techniques and anaesthetic management have largely contributed to improved outcome in lung cancer surgery. The purpose of this study was to identify predictors of post-operative cardiopulmonary morbidity in patients with a forced expiratory volume in 1 s ,80% predicted, who underwent cardiopulmonary exercise testing (CPET).In this observational study, 210 consecutive patients with lung cancer underwent CPET with completed data over a 9-yr period (2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009).Cardiopulmonary complications occurred in 46 (22%) patients, including four (1.9%) deaths. On logistic regression analysis, peak oxygen uptake (peak V9O 2 ) and anaesthesia duration were independent risk factors of both cardiovascular and pulmonary complications; age and the extent of lung resection were additional predictors of cardiovascular complications, whereas tidal volume during one-lung ventilation was a predictor of pulmonary complications. Compared with patients with peak V9O 2 .17 mL?kg, those with a peak V9O 2 ,10 mL?kg -1 ?min -1 had a four-fold higher incidence of cardiac and pulmonary morbidity. Our data support the use of pre-operative CPET and the application of an intra-operative protective ventilation strategy. Further studies should evaluate whether pre-operative physical training can improve post-operative outcome.

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Value of perioperative Doppler echocardiography in patients undergoing major lung resection

Cited by 62 publications

References 15 publications

Tissue Doppler evaluation of the right ventricle in major pulmonary resections

Tissue Doppler evaluation of the right ventricle in major pulmonary resections

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

Impact of aerobic exercise capacity and procedure-related factors in lung cancer surgery

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