Impact of Major Pulmonary Resections on Right Ventricular Function: Early Postoperative Changes.

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 fraction, and right ventricular end diastolic volume index are significantly affected by pulmonary resection.

Total Correction of Tetralogy of Fallot at Early Age: A Study of 183 Cases.

BACKGROUND: Opinions regarding the optimal time for the repair of tetralogy of Fallot vary. A debate also exists about the timing of repair for the asymptomatic infant. METHODS: This study included 183 patients with tetralogy of Fallot. All patients were subjected to clinical examination with measurement of oxygen saturation, 12-lead ECG, plain chest x-ray, and complete laboratory investigation. Echocardiography and cardiac catheterisation were indicated if there was an inability to reach diagnosis by echocardiography, suspicion of coronary anomaly, evaluation of distal pulmonary arteries or suspicion of major aorto-pulmonary collaterals. Complete repair was done in all patients. Patients were divided into two groups for comparison. Group 1 (147 patients, 1-year-old or less), and Group 2 (36 patients older than 1 year). RESULTS: Three patients died in Group1 (2.04%) while there was no early mortality in Group 2 patients. Six patients in Group 1 (4.08%) were reoperated for significant residual or recurrent right ventricular outflow stenosis, three patients (2.04%) were reoperated for residual significant shunt, and three patients (2.04%) were reoperated for residual significant stenosis and residual significant shunt. That is in addition to three patients (2.04%) who had significant tricuspid regurgitation, three more patients (2.04%) who needed a permanent pacemaker implantation, and nine patients (6.1%) who had significant postoperative pulmonary valve regurgitation. On the other hand, for Group 2 patients, there were only three patients who were reoperated for postoperative restenosis and significant shunt, three patients who were reoperated for permanent pacemaker implantation, and another two patients who had insignificant restenosis to be followed up. CONCLUSIONS: Early complete tetralogy of Fallot repair can be accomplished with a low mortality.

Predictive factors of supraventricular arrhythmias after noncardiac thoracic surgery: a multicenter study.

BACKGROUND: Supraventricular cardiac arrhythmias are the most common rhythm disturbances in patients following thoracic surgery. The purpose of our study was to determine which of the clinical parameters are the most valuable in predicting postoperative atrial fibrillation (AF) after lung surgery. METHODS: Retrospective analysis was carried out on 987 patients after noncardiac thoracic surgery to define the prevalence, associated risk factors, and clinical course of postoperative arrhythmias. There were 822 men and 165 women, age 34 to 78 years (mean age: 61 ± 8 years). The patients were divided into two groups depending on the occurrence or absence of supraventricular arrhythmia. Group I consisted of 876 patients who were free from rhythm disturbances. The remaining 111 patients exhibited episodes of supraventricular arrhythmia (29 supraventricular tachycardia; 82 AF). These 111 patients were placed in Group II. Preoperative, operative, and postoperative data were reviewed. Statistical analysis was performed. RESULTS: A statistically significant difference was found between the two groups in age, previous history of heart disease, and lung resection, especially pneumonectomy. CONCLUSION: Age, history of prior heart disease, lung resection, and the extent of pulmonary resection are the main risk factors for postoperative supraventricular arrhythmia in patients undergoing major thoracic operations.