Development of pulmonary hypertension after lung volume reduction surgery.

This prospective, longitudinal study was designed to assess the hemodynamic changes occurring in patients who undergo lung volume reduction surgery (LVRS). Patients with emphysema treated with LVRS underwent hemodynamic evaluation before and after surgery. The study group consisted of nine patients with an average age of 64.4 yr. FEV1 rose significantly from 0.64 preoperatively to 0.99 L postoperatively. After surgery, pulmonary artery (PA) systolic pressure rose to 47.9 +/- 12.4 mm Hg, meeting criteria for development of pulmonary hypertension. In six patients, the elevation in PA pressure was attributed to an increase in the pulmonary vascular resistance, but for all nine patients the change was not statistically significant. The pulmonary artery occulsion pressure (PAOP) did not change postoperatively. There was no correlation of PAOP with global left ventricular ejection fraction. While preoperatively there was a negative correlation between symptoms (Mahler dyspnea index) and PA pressure, after surgery the change in PA pressures did not correlate with the change in symptoms (Mahler transitional dyspnea index). We concluded that development of pulmonary hypertension may occur after LVRS in patients whose symptomatic status improves and in whom this condition was not present preoperatively.

Cardiac metastasis from adenocarcinoma of the lung. Echocardiographic-pathologic correlation.

Metastatic cancer to the heart is difficult to diagnose ante-mortem. This report describes a patient with adenocarcinoma of the lung who presented with cardiac manifestations mimicking coronary artery disease. Two-dimensional echocardiography demonstrated massive cardiac infiltration with tumor, correlating with subsequent autopsy findings, which were also remarkable for endocardial implants and coronary artery emboli without myocardial infarction. Use of two-dimensional echocardiography may detect intracardiac tumor at an earlier stage.