Abstract
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 12
th
, 24
th
and 48
th
hours
postoperative records of cardiac index; while 3
rd
and 6
th
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.