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Clinical InvestigationsSURGERYEffects of Lung Volume Reduction Surgery on Left Ventricular Diastolic Filling and Dimensions in Patients With Severe Emphysema*
Section snippets
Patients
The local Ethics Committee of the Medical Faculty of Go¨teborg University approved the study protocol. Twenty patients were included in the study. The LVRS group consisted of 10 consecutive patients who were scheduled for LVRS due to severe pulmonary emphysema (ie, the LVRS group), whereas 10 patients scheduled for lobectomy due to pulmonary carcinoma served as control subjects (ie, the control group).
The criteria for inclusion in the LVRS group were as follows: a diagnosis of emphysema based
Patients
The patients in the LVRS group consisted of five men and five women, whereas six women and four men were included in the control group. There were no differences between the groups regarding age, height, or weight (Table 1). As shown in Table 2, the patients undergoing LVRS had the typical functional features of severe pulmonary emphysema, consisting of severe obstruction to expiratory airflow and considerable hyperinflation. The mean SPAP was 34 ± 3 mm Hg, and the mean LV AEF was 62 ± 2%, as
Discussion
We investigated LV performance in a group of patients with severe pulmonary emphysema who were undergoing LVRS. To compare these patients to nonemphysematous patients with regard to central hemodynamics and LV function, and to exclude the surgical procedure per se as the source of potential effects, we included a control group of patients undergoing lobectomy for pulmonary carcinoma (ie, the lobectomy group). Preoperative LV performance was depressed in patients with severe pulmonary emphysema
Conclusion
In the present study, we evaluated the immediate effects of LVRS for severe emphysema on LV end-diastolic filling, dimensions, and stiffness as well as pulmonary and systemic hemodynamics in comparison with pulmonary lobectomy for lung cancer. Before surgery, the LVRS group had a lower LV performance, as demonstrated by lower values for SVI, SWI, and CI when compared with the lobectomy group. This was due to a lower baseline LV preload, as indicated by the presence of a lower LV EDAI and mitral
References (33)
- et al.
Bilateral pneumectomy (volume reduction) for chronic obstructive pulmonary disease
J Thorac Cardiovasc Surg
(1995) - et al.
Reduction pneumoplasty versus respiratory rehabilitation in severe emphysema: a randomized study; Pulmonary Emphysema Research Group
Ann Thorac Surg
(2000) Lung volume reduction surgery: answering the crucial questions
Chest
(1998)- et al.
Correlation of changes in quality of life after lung volume reduction surgery with changes in lung function exercise, and gas exchange
Chest
(2000) - et al.
Influence of positive end-expiratory pressure on right and left ventricular performance assessed by Doppler two-dimensional echocardiography
Chest
(1994) - et al.
Transesophageal two-dimensional echocardiographic evaluation of biventricular dimension and function during positive end-expiratory pressure ventilation after coronary artery bypass grafting
Am J Cardiol
(1987) - et al.
Analysis of early transmitral Doppler velocity curve: effect of primary physiologic changes and compensatory preload adjustment
J Am Coll Cardiol
(1990) - et al.
Transesophageal pulsed-Doppler echocardiographic evaluation of transmitral and pulmonary venous flow during ventilation with positive end-expiratory pressure
J Cardiothorac Vasc Anesth
(1994) - et al.
Effects of lung volume reduction surgery on exercise pulmonary hemodynamics in severe emphysema
Chest
(1998) - et al.
A surgical approach to pulmonary emphysema
Am Rev Respir Dis
(1959)
Effects of lung-volume-reduction surgery in patients with severe emphysema
N Engl J Med
Prospective randomized trial comparing bilateral lung volume reduction surgery to pulmonary rehabilitation in severe chronic obstructive pulmonary disease
Am J Respir Crit Care Med
Lung volume reduction surgery versus conservative treatment in severe emphysema
Eur Respir J
Short-term and long-term outcomes after bilateral lung volume reduction surgery: prediction by quantitative CT
Chest
Physiological basis of improvement after lung volume reduction surgery: where are we?
Eur Respir J
Effects of adenosine infusion on systolic and diastolic left ventricular function after coronary artery bypass surgery: evaluation by computer assisted quantitative 2-D and Doppler echocardiography
Anesth Analg
Cited by (0)
This study was supported by grant No. 13156 from the Swedish Medical Research Council and by the Medical Faculty of Gothenburg (LUA).
This study was partly presented at the ninth Annual Meeting of the European Society of Anaesthesiologists, Gothenburg, Sweden, April 7–10, 2001, and at the Annual Meeting of the International Society of Heart and Lung Transplantation, Washington, DC, April 10–13, 2002.