Changes of pulmonary circulation and right ventricular function after lung volume reduction surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHAO Xudong ,  SHI Kaihu , CAO Wei , SHA Jiming

Department of Cardiothoracic Surgery of The Second Hospital of Anhui Medical University, Hefei, 230601, P.R.China;

Corresponding author：

SHI Kaihu, Email: zxdong8211@yeah.net

Keywords：

Lung volume reduction; right ventricular function; pulmonary circulation

DOI：

10.7507/1007-4848.201507049

Video：

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Objective To investigate the changes of pulmonary circulation and right ventricular function after lung volume reduction surgery. Methods We retrospectively analyzed the clinical data of 34 patients of severe chronic obstructive pulmonary disease with single or double lung volume reduction surgery through thoracoscope in our hospital from 2013 through 2014. Ultrasonic testing was conducted peroperatively, on postoperative day 3–5, at 1 month and 3 months after surgery. Results Right ventricular stroke volume (61.00±10.54 ml vs. 38.34±10.04 ml) and right ventricular ejection fraction decreased (58.00%±9.00% vs. 49.00%±10.00%), mean pulmonary arterial pressure (23.35±5.07 mm Hg vs. 29.57±6.32 mm Hg) and total pulmonary vascular resistance (9.28±2.14 mm Hg vs. 12.05±4.36 mm Hg) increased with statistical differences (P＜0.05) on postoperative day 3–5. Right heart ejection fraction was 51%±11% with a statistical increase (P＜0.05) at 1 month after surgery. There was no statistical difference in indicators above between 3 months after surgery and before surgery. Conclusion Changes of pulmonary circulation and right ventricular function may be temporary. Right ventricular dysfunction decreases, pulmonary arterial pressure, and total pulmonary vascular resistance increases on postoperative day 3–5 d. But the changes gradually recover in 1–3 months after surgery, and could be gradually restored to preoperative level.

Citation： ZHAOXudong, SHIKaihu, CAOWei, SHAJiming. Changes of pulmonary circulation and right ventricular function after lung volume reduction surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(1): 16-19. doi: 10.7507/1007-4848.201507049 Copy

1.	Brantigan OC, Mueller E. Surgical treatment of pulmonary emphysema. Am Surg, 1957, 23(9): 789-804.
2.	Cooper JD, Patterson GA, Sundaresan RS, et al. Results of 150 consecutive bilateral lung volume reduction procedures in patients with severe emphysema. J Thorac Cardiovasc Surg, 1996, 12(6): 1319-1329.
3.	秦卫, 张爱平, 郑琳, 等. 电视胸腔镜双侧肺减容术 21 例. 中国胸心血管外科临床杂志, 2012, 19(4): 444-446.
4.	Boasquevisque CH, Yildirim E, Waddel TK, et al. Surgical techniques: lung transplant and lung volume reduction. Proc Am Thorac Soc, 2009, 6(2): 66-78.
5.	周嘉, 陈长志, 陈彤宇, 等. 重度肺气肿合并难治性气胸的外科治疗. 中国胸心血管外科临床杂志, 2004, 11(4): 304-305.
6.	Cremona G, Barbara JA, Melgosa T, et al. Mechanisms of gas exchange response to lung volume reduction surgery in severe emphysema. J Appl Physiol, 2011, 110(7): 1036-1045.
7.	Sharafkhaneh A, Rodarte J, Boriek A, et al. Altered thoracic gas compression contributes to improvement in spirometry with lung volume reduction surgery. Thorax, 2005, 60(2): 288-292.
8.	Marchand E, Gayan Ramirez G, De Leyn P, et al. Physiological effects of lung rdeuction surgery: the contribution of fin animal model of emphysema. Rev Mal Respir, 2003, 20(7): 539-548.
9.	Sciurba FC. Early and long-term functional outcomes following lung volume reduction surgery. Clin Chest Med, 1997, 18(3): 259-276.
10.	Holverda S, Rietema H, Westerhof N, et al. Stroke volume increase in exercise in chronic obstructive pulmonary disease is limited by increased pulmonary artery pressure. Heart, 200, 95(2): 137-141.
11.	Jörgensen K, Müller MF, Nel J, et al. Reduced intrathoracic blood volume and left and right ventricular dimensions in patients with severe emphysema: an MRI study. Chest, 2007, 131(11): 1050-1057.
12.	Nakhjavan FK, Palmer WH, McGregor M. Influence of respiration on venous return in pulmonary emphysema. Circulation, 1966, 33(1): 8-16.
13.	Even P, Sors H, Safran D, et al. Hémodynamiquedes bulles demphysème un noveau syndrome: La tamponade cardiaque emphysématouse. Rev Fr Mal Respir, 2008, 8(2): 117-120.
14.	Sciurba FC, Rogers RM, Keenan RJ, et al. Improvement in pulmonary function and elastic recoil after lung-reduction surgery for diffuse emphysema. N Engl J Med, 1996, 334(12): 1095-1099.
15.	Mineo TC, Pompeo E, Rogliani P, et al. Effect of lung volume reduction surgery for severe emphysema on right ventricular function. Am J Respir Crit Care Med, 2002, 165(5): 489-494.
16.	Weg IL, Rossoff L, McKeon K, et al. Development of pulmonary hypertension after lung volume reduction surgery. Am J Respir Crit Care Med, 1999, 159(6): 552-555.
17.	Butler J, Schrijen F, Henriquez A, et al. Cause of the raised wedge pressure on exercise in chronic obstructive pulmonary disease. Am Rev Respir Dis, 1988, 138(4): 350-354.
18.	Haniuda M, Kubo K, Fujimoto K, et al. Different effects of lung volume reduction surgery and lobectomy on pulmonary. Ann Surg, 2000, 231(1): 119-125.

1. Brantigan OC, Mueller E. Surgical treatment of pulmonary emphysema. Am Surg, 1957, 23(9): 789-804.
2. Cooper JD, Patterson GA, Sundaresan RS, et al. Results of 150 consecutive bilateral lung volume reduction procedures in patients with severe emphysema. J Thorac Cardiovasc Surg, 1996, 12(6): 1319-1329.
3. 秦卫, 张爱平, 郑琳, 等. 电视胸腔镜双侧肺减容术 21 例. 中国胸心血管外科临床杂志, 2012, 19(4): 444-446.
4. Boasquevisque CH, Yildirim E, Waddel TK, et al. Surgical techniques: lung transplant and lung volume reduction. Proc Am Thorac Soc, 2009, 6(2): 66-78.
5. 周嘉, 陈长志, 陈彤宇, 等. 重度肺气肿合并难治性气胸的外科治疗. 中国胸心血管外科临床杂志, 2004, 11(4): 304-305.
6. Cremona G, Barbara JA, Melgosa T, et al. Mechanisms of gas exchange response to lung volume reduction surgery in severe emphysema. J Appl Physiol, 2011, 110(7): 1036-1045.
7. Sharafkhaneh A, Rodarte J, Boriek A, et al. Altered thoracic gas compression contributes to improvement in spirometry with lung volume reduction surgery. Thorax, 2005, 60(2): 288-292.
8. Marchand E, Gayan Ramirez G, De Leyn P, et al. Physiological effects of lung rdeuction surgery: the contribution of fin animal model of emphysema. Rev Mal Respir, 2003, 20(7): 539-548.
9. Sciurba FC. Early and long-term functional outcomes following lung volume reduction surgery. Clin Chest Med, 1997, 18(3): 259-276.
10. Holverda S, Rietema H, Westerhof N, et al. Stroke volume increase in exercise in chronic obstructive pulmonary disease is limited by increased pulmonary artery pressure. Heart, 200, 95(2): 137-141.
11. Jörgensen K, Müller MF, Nel J, et al. Reduced intrathoracic blood volume and left and right ventricular dimensions in patients with severe emphysema: an MRI study. Chest, 2007, 131(11): 1050-1057.
12. Nakhjavan FK, Palmer WH, McGregor M. Influence of respiration on venous return in pulmonary emphysema. Circulation, 1966, 33(1): 8-16.
13. Even P, Sors H, Safran D, et al. Hémodynamiquedes bulles demphysème un noveau syndrome: La tamponade cardiaque emphysématouse. Rev Fr Mal Respir, 2008, 8(2): 117-120.
14. Sciurba FC, Rogers RM, Keenan RJ, et al. Improvement in pulmonary function and elastic recoil after lung-reduction surgery for diffuse emphysema. N Engl J Med, 1996, 334(12): 1095-1099.
15. Mineo TC, Pompeo E, Rogliani P, et al. Effect of lung volume reduction surgery for severe emphysema on right ventricular function. Am J Respir Crit Care Med, 2002, 165(5): 489-494.
16. Weg IL, Rossoff L, McKeon K, et al. Development of pulmonary hypertension after lung volume reduction surgery. Am J Respir Crit Care Med, 1999, 159(6): 552-555.
17. Butler J, Schrijen F, Henriquez A, et al. Cause of the raised wedge pressure on exercise in chronic obstructive pulmonary disease. Am Rev Respir Dis, 1988, 138(4): 350-354.
18. Haniuda M, Kubo K, Fujimoto K, et al. Different effects of lung volume reduction surgery and lobectomy on pulmonary. Ann Surg, 2000, 231(1): 119-125.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Changes of pulmonary circulation and right ventricular function after lung volume reduction surgery

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