title: Preoperative pulmonary vascular morphology and its relationship to postpneumonectomy hemodynamics.
abstract: OBJECTIVE
  Pulmonary edema and pulmonary hypertension are postsurgical complications of pneumonectomy that may represent the remaining pulmonary vasculature's inability to accommodate the entirety of the cardiac output. Quantification of the aggregate pulmonary vascular cross-sectional area (CSA) has been used to study the development of pulmonary vascular disease in smokers. In this study, we applied this technique to demonstrate the potential utility of pulmonary vascular quantification in surgical risk assessment. Our hypothesis was that those subjects with the lowest aggregate vascular CSA in the nonoperative lung would be most likely to have elevated pulmonary vascular pressures in the postoperative period.
  
  
  METHODS
  A total of 61 subjects with postoperative hemodynamics and adequate imaging were identified from 159 patients undergoing pneumonectomies for mesothelioma. The total CSA of blood vessels perpendicular to the plane of computed tomographic (CT) scan slices was computed for blood vessels <5 mm(2) (CSA 5 mm). This measurement expressed as a percentage of lung parenchyma area (CSA 5%) was compared to postoperative hemodynamic measurements obtained by right heart catheterization.
  
  
  RESULTS
  In patients where a contrasted CT scan was used (n = 26), CSA 5% was correlated with postoperative day 0 minimum cardiac index (R = 0.37, P = .03) but not with the maximum pulmonary arterial pressures. In patients with noncontrast CT scans (n = 35), CSA 5% was inversely correlated with postoperative day 0 maximum pulmonary arterial pressures (R = 0.43, P = .03) but not with the minimum cardiac index. The preoperative perfusion fraction of the nonsurgical lung did not correlate with postoperative hemodynamics.
  
  
  CONCLUSIONS
  CSA of pulmonary vasculature with an area ≤5 mm(2) has potential in estimating the ability of pulmonary vascular bed to accommodate postsurgical changes in pneumonectomy.
authors.affiliation: Pulmonary and Critical Care Division of Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, PBB CA-3, Boston, Massachusetts 02115. Electronic address: frahaghi@partners.org.
authors.forename: Farbod N
authors.initials: FN
authors.lastname: Rahaghi
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine and Critical Care Medicine, Brigham and Women's Hospital, 75 Francis Street, CWN-L1, Boston, Massachusetts 02115.
authors.forename: Daniel
authors.initials: D
authors.lastname: Lazea
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine and Critical Care Medicine, Brigham and Women's Hospital, 75 Francis Street, CWN-L1, Boston, Massachusetts 02115.
authors.forename: Saba
authors.initials: S
authors.lastname: Dihya
authors.affiliation: Department of Radiology, Harvard School of Medicine, Surgical Planning Laboratory, 1249 Boylston Street, 2nd Floor, Room 216, Boston, Massachusetts 02215.
authors.forename: Raúl
authors.initials: R
authors.lastname: San José Estépar
authors.affiliation: Division of Thoracic Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts 02115.
authors.forename: Raphael
authors.initials: R
authors.lastname: Bueno
authors.affiliation: Division of Thoracic Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts 02115.
authors.forename: David
authors.initials: D
authors.lastname: Sugarbaker
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine and Critical Care Medicine, Brigham and Women's Hospital, 75 Francis Street, CWN-L1, Boston, Massachusetts 02115.
authors.forename: Gyorgy
authors.initials: G
authors.lastname: Frendl
authors.affiliation: Pulmonary and Critical Care Division of Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, PBB CA-3, Boston, Massachusetts 02115.
authors.forename: George R
authors.initials: GR
authors.lastname: Washko
mesh_terms: D015331:Cohort Studies; D003287:Contrast Media; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging; D008171:Lung Diseases / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D057234:Preoperative Period; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D011652:Pulmonary Circulation / Q000502:physiology; D011654:Pulmonary Edema / Q000000981:diagnostic imaging; D011856:Radiographic Image Enhancement / Q000379:methods; D018570:Risk Assessment / Q000379:methods / Q000706:statistics & numerical data; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media
keywords: CSA; Pneumonectomy; hemodynamics; vasculature