Background: Right ventricular (RV) dysfunction after pulmonary resection in the early postoperative period documented by reduced RV ejection fraction and increased RV end-diastolic volume index. Supraventricular arrhythmia particularly atrial fibrillation is common after pulmonary resection. RV assessment can be done by non- invasive methods and/or invasive approaches as right cardiac catheterization. Incorporation of a rapid response thermistor to pulmonary artery catheter permitted continuous measurements of cardiac output, right ventricular ejection fraction and right ventricular end- diastolic volume, also it’s used for right atrial and right ventricular pacing, and for measuring right-sided pressures, including pulmonary capillary wedge pressure. Methods: This study included 178 patients underwent major pulmonary resections, 36 underwent pneumonectomy assigned as group (I) and 142 underwent lobectomy assigned as group (II). The study was conducted at cardiothoracic surgery department of Benha university hospital in Egypt; patients enrolled are done from February 2012 to February 2016. A rapid response thermistor pulmonary artery catheter inserted via the right internal jugular vein. Preoperatively; central venous pressure, mean pulmonary artery pressure, pulmonary capillary wedge pressure, cardiac output, right ventricular ejection fraction and volumes recorded, same parameters were collected in fixed time intervals after 3 hours, 6 hours, 12 hours, 24 hours and 48 hours postoperatively. Results: For group (I): There were no statistically significant changes between the preoperative and postoperative records in the central venous pressure and mean arterial pressure, also there were no statistically significant changes in the preoperative and 12th , 24th and 48th hours postoperative records of cardiac index; while 3rd and 6th hours postoperative showed significant changes. There were statistically significant changes between the preoperative and postoperative records of heart rate, mean pulmonary artery pressure, pulmonary capillary wedge pressure, pulmonary vascular resistance, right ventricular ejection fraction and right ventricular end diastolic volume index, in all postoperative records. For group (II): There were no statistically significant changes between the preoperative and all postoperative records in the central venous pressure, mean arterial pressure and cardiac index. There were statistically significant changes between the preoperative and postoperative records of heart rate, mean pulmonary artery pressure, pulmonary capillary wedge pressure, pulmonary vascular resistance, right ventricular ejection fraction and right ventricular end diastolic volume index in all postoperative records. There were statistically significant changes between the two groups in all postoperative records of heart rate, mean pulmonary artery pressure, pulmonary capillary wedge pressure, pulmonary vascular resistance, right ventricular ejection fraction and right ventricular end diastolic volume index. Conclusion: There is right ventricular dysfunction early after major pulmonary resection by increased right ventricular afterload, this dysfunction is more in pneumonectomy than 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. |
