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Long-term Doppler echocardiographic evaluation of the right heart after major lung resections

^a Department of Thoracic Surgery, University of Rome "La Sapienza", Italy
^b Department of Cardiology, University of Rome "La Sapienza", Italy

Received 20 April 2007; received in revised form 23 July 2007; accepted 30 July 2007.

^_* Corresponding author. Address: Cattedra di Chirurgia Toracica, Policlinico Umberto I, University of Rome "La Sapienza", V.le del Policlinico, 00100 Rome, Italy. Tel.: +39 06 4461971; fax: +39 06 49970735. (Email: sofed{at}libero.it).

Objective: The effects of major lung resections on cardiac function in the medium and long term have not been thoroughly evaluated. We have studied right heart function with serial Doppler echocardiography in patients undergoing lobectomy and pneumonectomy during 4 years of follow-up after surgery. Methods: Thirty-six patients undergoing lobectomy and 15 receiving pneumonectomy were evaluated with one- and two-dimensional Doppler standard transthoracic echocardiography before surgery and 1 week, 3 months, 6 months, 1 year, and 4 years postoperatively. We have studied the right midventricular diastolic diameter (RVDD), the right ventricle free wall thickness, the tricuspid valve insufficiency (TVI) and regurgitation jet (TRJ), and the pulmonary artery systolic pressure (PASP). Results: None of the patients died within the first postoperative year. After lobectomy there were no significant modifications of any variable at any time. RVDD progressively increased after pneumonectomy (26.5 ± 2.2 mm preoperatively vs 34.3 ± 7.6 at 4 years; p < 0.001). Four years after surgery all patients undergoing pneumonectomy had moderate TVI while only 55% of patients receiving lobectomy showed it (low grade in 50% and moderate in 5%). In this group of patients PASP increased from 26.1 ± 2.6 mmHg preoperatively to 34.3 ± 7.6 mmHg at 4 years (p < 0.00001). Conclusions: Right ventricle modifications are clearly evident after pneumonectomy and even if they do not show a clear clinical impact they should not be neglected.

Key Words: Pneumonectomy • Doppler echocardiography • Right ventricle • Pulmonary artery pressure