Atelectasis and gas exchange after cardiac surgery.
BACKGROUND
Sometimes a high intrapulmonary shunt occurs after cardiac surgery, and impairment of lung function and oxygenation can persist for 1 week after operation. Animal studies have shown that postoperative shunt can be explained by atelectasis. In this study the authors tried to determine if atelectasis can explain shunt in patients who have had cardiac surgery.


METHODS
Nine patients having coronary artery bypass graft surgery and nine patients having mitral valve surgery were examined using the multiple inert gas elimination technique before and after operation. On the first postoperative day, computed tomography scans were made at three levels of the thorax.


RESULTS
Before anesthesia, the average shunt was low (2+/-3%; range, 0-13%), but on the first postoperative day shunt had increased to 12+/-60% (range, 3-28%). The computed tomography scans showed bilateral dependent densities in all patients but one. The mean area of the densities was 8+/-8% (range, 0-37%) of total lung area, corresponding to a calculated fraction of collapsed lung tissue of 20+/-14% (range, 0-59%). In the basal region, the calculated amount of collapsed tissue was 28+/-19% (range, 0-73%). One mitral valve patient was an outlier and had a large shunt both before and after the operation.


CONCLUSIONS
Large atelectasis in the dorsal part of the lungs was found on the first postoperative day after cardiac surgery. However, there was no clear correlation between atelectasis and measured shunt fraction.
Tenling
A
A
Department of Cardiothoracic Anesthesia, University Hospital, Uppsala, Sweden. Arne.Tenling@KlinFys.uu.se
Hachenberg
T
T
Tydén
H
H
Wegenius
G
G
Hedenstierna
G
G
D000368:Aged; D000758:Anesthesia; D006348:Cardiac Surgical Procedures; D001026:Coronary Artery Bypass; D005260:Female; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology; D006801:Humans; D008168:Lung / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D010101:Oxygen Consumption / Q000502:physiology; D001261:Pulmonary Atelectasis / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011659:Pulmonary Gas Exchange / Q000502:physiology*; D012121:Respiration, Artificial; D012129:Respiratory Function Tests; D014057:Tomography, X-Ray Computed; D014692:Ventilation-Perfusion Ratio