title: Preoperative cardiac and pulmonary assessment in bariatric surgery.
abstract: BACKGROUND
  Morbidly obese patients have a high prevalence of known and unknown cardiopulmonary diseases. The aim of this study was to assess the value of cardiopulmonary tests routinely performed before bariatric surgery.
  
  
  METHODS
  The population studied included 67 women and 10 men, aged 39 +/- 10 years, with a body mass index of 43 +/- 4 kg/m2. All patients, candidates for laparoscopic gastric banding, underwent after clinical evaluation: resting electrocardiography (ECG), Doppler-echocardiography, exercise stress testing, Epworth Sleepness Scale, and polysomnography, spirometry, blood gases, and chest x-ray.
  
  
  RESULTS
  The ECG demonstrated conduction or ST-T wave abnormalities in 48 patients (62%). Prolongation of the QT interval >10% was found in 13 patients (17%). Stress tests were negative in 56 patients (73%) and were not interpretable in the remaining 21 patients (27%). Doppler-echocardiography showed hypertrophy of the left ventricular posterior wall in 47 patients (61%) without any consequences on perioperative management. Polysomnography showed an obstructive sleep apnea-hypopnea syndrome (OSAHS) in 31 patients (40%), leading to preoperative continuous positive airway pressure (CPAP) treatment in 17 patients (22%). Nevertheless, the Epworth Sleepness Scale was pathological in only 17 patients (22%). Ten patients (13%) presented minor chest x-ray alterations. Spirometry demonstrated an obstructive respiratory syndrome in 13 patients (17%) and a restrictive syndrome in five patients (6%). Hypoxemia <80 mmHg was observed in 21 patients (27%) and hypercapnia >45 mmHg in six patients (8%), without any consequences on the management of the perioperative period.
  
  
  CONCLUSIONS
  We recommend the preoperative assessment by clinical evaluation, ECG, and polysomnography. For patients with cardiac or pulmonary histories and/or ECG abnormalities, we recommend echocardiography, spirometry, and blood gases.
authors.affiliation: Bariatric Surgical College, Hôpital Avicenne Assistance Publique - Hôpitaux de Paris, Bobigny, France. jean-marc.catheline@avc.aphp.fr
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Catheline
authors.forename: Hélène
authors.initials: H
authors.lastname: Bihan
authors.forename: Toan
authors.initials: T
authors.lastname: Le Quang
authors.forename: Danièle
authors.initials: D
authors.lastname: Sadoun
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Charniot
authors.forename: Igor
authors.initials: I
authors.lastname: Onnen
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Fournier
authors.forename: Joseph
authors.initials: J
authors.lastname: Bénichou
authors.forename: Régis
authors.initials: R
authors.lastname: Cohen
mesh_terms: D000328:Adult; D001784:Blood Gas Analysis; D003955:Diagnostic Tests, Routine; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D015391:Gastroplasty; D006334:Heart Function Tests; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D017286:Polysomnography; D013902:Radiography, Thoracic; D012129:Respiratory Function Tests