Adjustments in cardiorespiratory function after pneumonectomy: Results of the pneumonectomy project Deslauriers, Jean, MD; Ugalde, Paula, MD; Miro, Santiago, MD ...
Journal of thoracic and cardiovascular surgery/The Journal of thoracic and cardiovascular surgery/The journal of thoracic and cardiovascular surgery,
2011, 2011-Jan, 2011-01-00, 20110101, Letnik:
141, Številka:
1
Journal Article
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Objective To assess lung function, gas exchange, exercise capacity, and right-sided heart hemodynamics, including pulmonary artery pressure, in patients long term after pneumonectomy. Methods Among ...523 consecutive patients who underwent pneumonectomy for lung cancer between January 1992 and September 2001, 117 were alive in 2006 and 100 were included in the study. During a 1-day period, each patient had complete medical history, chest radiographs, pulmonary function studies, resting arterial blood gas analysis, 6-minute walk test, and Doppler echocardiography. Results Most patients (N = 73) had no or only minimal dyspnea. On the basis of predicted values, functional losses in forced expiratory volume in 1 second and forced vital capacity were 38% ± 18% and 31% ± 24%, respectively, and carbon monoxide diffusing capacity decreased by 31% ± 18%. There was a significant correlation between preoperative and postoperative forced expiratory volume in 1 second ( P < . 01), and more hyperinflation was associated with better lung function ( P < . 01 for forced expiratory volume in 1 second). Gas exchange was normal at rest (P ao2 = 88 ± 10 mm Hg; P aco2 = 42 ± 3 mm Hg), and exercise tolerance (6-minute walk) was also normal (83% ± 17% of predicted values). Thirty-two patients had some degree of pulmonary hypertension, but in most of those cases, it was mild to moderate (mean systolic pressure of 36 ± 9 mm Hg) and not associated with significant differences in lung function ( P = . 57 for forced expiratory volume in 1 second), gas exchange ( P = . 08), and exercise capacity ( P = . 66). Conclusions These findings indicate that despite worsening of lung function by approximately 30% after pneumonectomy, most patients can adjust to living with only 1 lung. Pulmonary hypertension is uncommon and in most cases only mild to moderate.
The physiologic advantages of preserving phrenic nerve integrity and normal diaphragmatic motion (DM) during the course of pnemonectomy are incompletely understood. This study was conducted to ...investigate potential benefits of this strategy on postoperative lung function.
Among 523 consecutive patients who underwent pneumonectomy for lung cancer between January 1992 and September 2001, 117 were alive at the time of study (March to December 2006) and thus had 5 years' minimum follow-up. Of those, 17 were excluded and 12 could not have magnetic resonance imaging (MRI), leaving 88 patients available for study. Diaphragmatic motion was assessed by MRI during deep breathing, and patients were classified as having normal and synchronous diaphragmatic motion (n = 44) or abnormal diaphragmatic motion (immobile or paradoxical, n = 44). These findings were correlated with expiratory volume measurements, gas exchange (arterial blood gases), and exercise tolerance (6-minute walk test).
The mean follow-up time was 9.3 years. Patients with abnormal DM were younger than patients with normal DM and were more likely to have had a right or an extended pneumonectomy (p < 0.01). Despite comparable preoperative lung function, patients with abnormal DM had significantly worse postoperative lung volumes (forced expiratory voume in 1 second, forced vital capacity, lung diffusion capacity for carbon monoxide; p < 0.01) and exercise capacity (6-minute walk test, percent predicted, p < 0.05) than patients with normal DM.
Because the long-term effects of a paralyzed hemidiaphragm in pneumonectomy patients are characterized by significant alterations in lung function, all surgeons doing this type of work should take every precaution to avoid technical errors that could lead to phrenic nerve injury or interruption.
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