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Ann Thorac Surg 2007;83:1986-1992
© 2007 The Society of Thoracic Surgeons

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Original Articles: General Thoracic

Cardiac Function and Position More Than 5 Years After Pneumonectomy

^a Department of Pulmonary Diseases, Catharina Hospital, Eindhoven, the Netherlands
^b Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands
^c Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
^d Department of Physics and Medical Technology, VU University Medical Center, Amsterdam, the Netherlands
^e Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, the Netherlands

Accepted for publication January 22, 2007.

^_* Address correspondence to Dr Vonk-Noordegraaf, Department of Pulmonary Diseases, VU University Medical Center, PO Box 7057, Amsterdam 1007 MB, the Netherlands (Email: a.vonk{at}vumc.nl).

Background: Pneumonectomy not only reduces the pulmonary vascular bed but also changes the position of the heart and large vessels, which may affect the function of the heart. We investigated long-term effects of pneumonectomy on right ventricular (RV) and left ventricular (LV) function and whether this function is influenced by the side of pneumonectomy or the migration of the heart to its new position.

Methods: In 15 patients who underwent pneumonectomy and survived for more than 5 years, we evaluated by dynamic magnetic resonance imaging the function of the RV and LV and the position of the heart within the thorax.

Results: Long-term effect of pneumonectomy on the position of the heart is characterized by a lateral shift after right-sided pneumonectomy and rotation of the heart after left-sided pneumonectomy. Postoperatively, heart rate was high (p = 0.006) and stroke volume was low (p = 0.001), compared with the reference values, indicating impaired cardiac function. Patients after right-sided pneumonectomy had an abnormal low RV end-diastolic volume of 99 ± 29 mL together with a normal LV function. No signs of RV hypertrophy were found. In left-sided pneumonectomy patients, RV volumes were normal whereas LV ejection fraction was abnormally low.

Conclusions: The long-term effects of pneumonectomy on the position of the heart are characterized by a lateral shift in patients after right-sided pneumonectomy and rotation of the heart in patients after left-sided pneumonectomy. Overall, cardiac function in long-term survivors after pneumonectomy is compromised, and might be explained by the altered position of the heart.

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Hyun-Sung Lee
Ann. Thorac. Surg. 2007 83: 1992. [Extract] [Full Text] [PDF]

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				H.-S. Lee Invited commentary Ann. Thorac. Surg., June 1, 2007; 83(6): 1992 - 1992. [Full Text] [PDF]