title: The UPAO test in preoperative evaluation for major pulmonary resection: an operative case with markedly improved ventilatory function after radical pulmonary resection for lung cancer associated with pulmonary emphysema.
abstract: A 65-year-old man was admitted to our hospital for treatment of a squamous cell carcinoma in his right lung. Respiratory function testing showed an extremely reduced forced expiratory volume in 1 second (FEV1) of 1.0 l (29.9% of predicted), and a reduced FEV1/FVC ratio of 24.1%. Arterial blood gases on room air showed a pH of 7.41, a PaCO(2) of 36.7 mmHg, and a PaO(2) of 79.3 mmHg. To assess the predictive postoperative cardiopulmonary function, unilateral pulmonary artery occlusion (UPAO) testing was performed. In the condition of right main PA occlusion, the mean pulmonary artery pressure (mPAP), cardiac index (CI) and total pulmonary vessel resistance index (TPVRI) was 18 mmHg, 3.2 l/min/m(2) and 443.37 dyne.sec.cm(-5)/m(2), respectively. He underwent a middle lobectomy with combined partial resection of both the upper and lower lobes. He also underwent simultaneous resection of a giant bulla arising from the right upper lobe as lung volume reduction surgery. At 80 days after the operation, his FEV1 rose to 1.88 l, and the PaO(2) on room air was improved to 88.9 mmHg. UPAO testing was suggested to be more useful than routine pulmonary function test to determine the accurate predictive postoperative cardiopulmonary function and to decide indication for a radical operation.
authors.affiliation: Department of Surgery, Kurume University School of Medicine, Fukuoka, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Hayashi
authors.forename: Shinzo
authors.initials: S
authors.lastname: Takamori
authors.forename: Masahiro
authors.initials: M
authors.lastname: Mitsuoka
authors.forename: Keisuke
authors.initials: K
authors.lastname: Miwa
authors.forename: Mari
authors.initials: M
authors.lastname: Fukunaga
authors.forename: Keiko
authors.initials: K
authors.lastname: Matono
authors.forename: Kazuo
authors.initials: K
authors.lastname: Shirouzu
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D011013:Pneumonectomy; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011651:Pulmonary Artery; D011656:Pulmonary Emphysema / Q000150:complications*; D012129:Respiratory Function Tests; D014057:Tomography, X-Ray Computed