Background: Right ventricular (RV) dysfunction after
pulmonary resection in the early postoperative period is 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 such as right cardiac catheterization.
Incorporation of a rapid response thermistor to pulmonary
artery catheter permits continuous measurements of cardiac
output, right ventricular ejection fraction, and right ventricular
end-diastolic volume. It can also be 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 who underwent
major pulmonary resections, 36 who underwent pneumonectomy
assigned as group (I) and 142 who underwent
lobectomy assigned as group (II). The study was conducted
at the cardiothoracic surgery department of Benha University
hospital in Egypt; patients enrolled were operated on from
February 2012 to February 2016. A rapid response thermistor
pulmonary artery catheter was inserted via the right internal
jugular vein. Preoperatively the following was recorded: central
venous pressure, mean pulmonary artery pressure, pulmonary
capillary wedge pressure, cardiac output, right ventricular
ejection fraction and volumes. The 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;
there were no statistically significant changes in the preoperative
and 12, 24, and 48 hour postoperative records for
cardiac index; 3 and 6 hours postoperative showed significant
changes. There were statistically significant changes between
the preoperative and postoperative records for 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 for the central venous pressure,
mean arterial pressure and cardiac index. There were
statistically significant changes between the preoperative and
postoperative records for 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 for 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 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
The Heart Surgery Forum #2017-1864
21 (1), 2018 [Epub January 2018]
doi: 10.1532/hsf.1864
Impact of Major Pulmonary Resections on Right Ventricular Function: Early
Postoperative Changes
Hany M. Elrakhawy, MD,1,2 Mohamed A. Alassal, MD,1,3 Ayman M. Shaalan, MD,1,4
Ahmed A. Awad, MB.BCh,5 Sameh Sayed, MD,6 Mohammad M. Saffan, MD1
1Cardiothoracic Surgery Department, Benha University, Benha, Egypt; 2Prince Mutaib Bin Abdul-Aziz Hospital, Sakaka, Al-Jouf,
Saudi Arabia; 3King Fahd Medical City, Riyadh, Saudi Arabia; 4Dallah Hospital, Cardiac Center, Riyadh, Saudi Arabia; 5Dallah
Hospital, Endocrinology Center, Riyadh, Saudi Arabia; 6Cardiothoracic Surgery Department, Assiut University, Assiut, Egypt
Received June 30, 2017; received in revised form August 16, 2017; accepted
August 24, 2017.
Correspondence: Hany Mohamed Elrakhawy, MD, Assistant Professor of
Cardiothoracic Surgery, Benha Faculty of Medicine, Benha University, Egypt
& Consultant of Thoracic Surgery, Prince Mutaib Bin Abdul-Aziz Hospital,
Sakaka, Al-Jouf, Saudi Arabia; (e-mail: hanyelrakhawy@yahoo.com).
Online address: http://journal.hsforum.com
Table 1. Demographic Data and Etiologies |
