Cardiac function and position more than 5 years after pneumonectomy.
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.
Smulders
Sietske A
SA
Department of Pulmonary Diseases, Catharina Hospital, Eindhoven, The Netherlands.
Holverda
Sebastiaan
S
Vonk-Noordegraaf
Anton
A
van den Bosch
Harrie C M
HC
Post
Johannes C
JC
Marcus
J Tim
JT
Smeenk
Frank W J M
FW
Postmus
Pieter E
PE
D000368:Aged; D000369:Aged, 80 and over; D005080:Exercise Test; D006321:Heart / Q000033:anatomy & histology* / Q000503:physiopathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects*; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000209:etiology; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis* / Q000209:etiology; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right