ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
 QUICK SEARCH:   [advanced]


     


Ann Thorac Surg 2010;89:347-352. doi:10.1016/j.athoracsur.2009.08.001
© 2010 The Society of Thoracic Surgeons

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by van der Plas, M. N.
Right arrow Articles by Bresser, P.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by van der Plas, M. N.
Right arrow Articles by Bresser, P.
Related Collections
Right arrow Lung - cancer


Original Articles: General Thoracic

Pulmonary Endarterectomy Improves Dyspnea by the Relief of Dead Space Ventilation

Mart N. van der Plas, MSa,*, Herre J. Reesink, MD, PhDa, Carel M. Roos, MDa, Reindert P. van Steenwijk, MDa, Jaap J. Kloek, MDb, Paul Bresser, MD, PhDa,c

a Department of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
b Department of Cardiothoracic Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
c Department of Respiratory Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands

Accepted for publication August 3, 2009.

* Address correspondence to Dr van der Plas, Academic Medical Centre, University of Amsterdam, Department of Respiratory Medicine, F5-260, PO Box 22700, Amsterdam, 1100 DE, the Netherlands (Email: m.n.vanderplas{at}amc.uva.nl).

Background: In chronic thromboembolic pulmonary hypertension (CTEPH), dyspnea is considered to be related to increased dead space ventilation caused by vascular obstruction. Pulmonary endarterectomy releases the thromboembolic obstruction, thereby improving regional pulmonary blood flow. We hypothesized that pulmonary endarterectomy reduces dead space ventilation and that this reduction contributes to attenuation of dyspnea symptoms.

Methods: In this follow-up study we assessed dead space ventilation, hemodynamic severity of disease, and symptomatic dyspnea in 54 consecutive CTEPH patients, before and 1 year after pulmonary endarterectomy. Dead space ventilation was calculated using the Bohr-Enghoff equation. Dyspnea was assessed by Borg scores and the New York Heart Association functional classification.

Results: Preoperatively, dead space ventilation was increased (0.40 ± 0.07) and correlated with severity of disease (mean pulmonary artery pressure: r = 0.49, p < 0.001; total pulmonary resistance: r = 0.53, p < 0.001), and resting (r = 0.35, p < 0.05) and post-exercise Borg dyspnea scores (r = 0.44, p < 0.01). Postoperatively, dead space ventilation (0.33 ± 0.08, p < 0.001) and dyspnea symptoms decreased significantly. Changes in symptomatic dyspnea were independently associated with changes in pulmonary hemodynamics and absolute dead space.

Conclusions: Dead space ventilation in CTEPH is increased and correlates significantly with hemodynamic severity of disease and dyspnea symptoms. Pulmonary endarterectomy decreases dead space ventilation. The induced change in dead space upon surgical removal of chronic thromboembolism contributes to the postoperative recovery of symptomatic dyspnea.




This article has been cited by other articles:


Home page
Eur J Cardiothorac SurgHome page
T. Kunihara, J. Gerdts, H. Groesdonk, F. Sata, F. Langer, D. Tscholl, D. Aicher, and H.-J. Schafers
Predictors of postoperative outcome after pulmonary endarterectomy from a 14-year experience with 279 patients
Eur J Cardiothorac Surg, July 1, 2011; 40(1): 154 - 161.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Respir. Crit. Care Med.Home page
P. Fedullo, K. M. Kerr, N. H. Kim, and W. R. Auger
Chronic Thromboembolic Pulmonary Hypertension
Am. J. Respir. Crit. Care Med., June 15, 2011; 183(12): 1605 - 1613.
[Abstract] [Full Text] [PDF]


Home page
CirculationHome page
M. R. Jaff, M. S. McMurtry, S. L. Archer, M. Cushman, N. Goldenberg, S. Z. Goldhaber, J. S. Jenkins, J. A. Kline, A. D. Michaels, P. Thistlethwaite, et al.
Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension: A Scientific Statement From the American Heart Association
Circulation, April 26, 2011; 123(16): 1788 - 1830.
[Full Text] [PDF]


Home page
Ann. Thorac. Surg.Home page
M. N. van der Plas, S. Surie, H. J. Reesink, R. P. van Steenwijk, J. J. Kloek, and P. Bresser
Longitudinal Follow-Up of Six-Minute Walk Distance After Pulmonary Endarterectomy
Ann. Thorac. Surg., April 1, 2011; 91(4): 1094 - 1099.
[Abstract] [Full Text] [PDF]


Home page
ChestHome page
D. Bonderman, A. M. Martischnig, K. Vonbank, M. Nikfardjam, B. Meyer, G. Heinz, W. Klepetko, R. Naeije, and I. M. Lang
Right Ventricular Load at Exercise Is a Cause of Persistent Exercise Limitation in Patients With Normal Resting Pulmonary Vascular Resistance After Pulmonary Endarterectomy
Chest, January 1, 2011; 139(1): 122 - 127.
[Abstract] [Full Text] [PDF]




HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2010 by The Society of Thoracic Surgeons.