Cardiac and respiratory changes in the medium term after lung resection

OBJECTIVE
The aim of this study was to assess the cardiac and respiratory functions at the 6th postoperative month, in lung cancer patients undergoing segmentectomy/lobectomy or pneumonectomy.

METHODS
Thirteen segmentectomy/lobectomy and 5 pneu-monectomy patients with lung cancer were consecutively enrolled between April 2012 and February 2014. All patients underwent respiratory function tests and transthoracic echo-cardiography preoperatively and at 6 months postopera-tively.

RESULTS
Left ventricular functions were unchanged post-operatively. In the segmentectomy/lobectomy group, there were no changes in the right ventricular fractional area change (RVFAC) or tricuspid annular plane systolic excursion (TAPSE). However, TAPSE decreased from 19 (17–21) to 15.5 (14 –16) mm in pneumonectomy patients (p=0.04). RVFAC was 59.5 (58–61) % preoperatively and 59 (58–61)% at 6 months postoperatively (p=0.049). Neither group showed differences in pulmonary acceleration time or diastolic and systolic ec¬centricity indices after operation. Tissue Doppler imaging (TDI) revealed no deterioration in the left ventricular functions, but right ventricular diastolic functions (tricuspid E’/A’) were impaired in both groups. Right ventricular S’, showing the systolic function, was slightly decreased in the pneumonectomy group, in addition to a decrease in isovolumic velocity and isovolumic acceleration (IVA). Only IVA was decreased, from 2.33 (1.79–3.14) to 2.17 (1.73–3.01) (p=0.001), in seg-mentectomy/lobectomy group.

CONCLUSION
Segmentectomy/lobectomy should be preferred over pneumonectomy when possible. Tissue Doppler imaging may be routinely used as a part of echocardiographic evalu¬ation in patients with a higher risk of right ventricular dysfunc¬tion and these patients should be candidates for a closer cardiovascular follow-up.