Evaluation of right ventricle indices changes after pneumonectomy and lobectomy surgery by ERNV scan.

introductionLung resection surgeries, including lobectomy and pneumonectomy, are cornerstone treatments for lung cancer and other severe pulmonary conditions. Despite their therapeutic benefits, these procedures can compromise cardiopulmonary function, potentially increasing right ventricular (RV) workload due to reduced pulmonary vascular capacity. Such changes may precipitate RV dysfunction, even in patients with normal preoperative cardiac profiles, contributing to postoperative morbidity like dyspnea and arrhythmias. While pulmonary function tests are standard for preoperative risk assessment, cardiac impacts—particularly on the RV—remain insufficiently characterized. This study employs Equilibrium radionuclide ventriculography (ERNV) scanning, a precise radionuclide ventriculography technique, to evaluate biventricular systolic and diastolic changes post-resection, supplemented by echocardiography to measure Right Ventricular Systolic Pressure (RVSP).

methodsTwenty patients (mean age 43.8 ± 8.3 years, 10 females, 10 male) undergoing lobectomy (n = 15) or pneumonectomy (n = 5) from March 2021 to September 2022 were prospectively studied at a tertiary university hospital. Patients with preexisting coronary disease, hypertension, or abnormal pulmonary function (e.g., predicted postoperative FEV1 or DLCO < 60%) were excluded. Cardiac function was assessed preoperatively and two months postoperatively using ERNV scans to quantify right and left ventricular ejection fraction (EF), peak filling rate (PFR), and time to peak filling rate (TPFR). Transthoracic echocardiography measured RVSP concurrently. Statistical analyses included paired t-tests to compare pre- and postoperative indices, general linear models to assess surgery type effects, and regression analyses to correlate resection extent with RV changes.

resultsLung resection significantly impaired cardiac performance. Right ventricular EF declined from 48.8 ± 2.6% to 43.7 ± 2.8% (p = 0.035) and left ventricular EF from 54.9 ± 2.7% to 51.3 ± 3.3% (p < 0.001). Diastolic function deteriorated, with the right PFR decreasing from 1.9 ± 0.2 to 1.7 ± 0.2 EDV/s (p < 0.001) and left PFR from 2.4 ± 0.1 to 2.2 ± 0.2 EDV/s (p = 0.001), while TPFR increased bilaterally (right: 151.8 ± 18.6 to 161.4 ± 17.6 ms, p < 0.001; left: 168.9 ± 11.7 to 176.1 ± 13.5 ms, p < 0.001). RVSP rose from 20 ± 2.6 to 24.9 ± 5.0 mmHg (p = 0.001). Pneumonectomy elicited greater reductions in RV indices than lobectomy, with resection extent strongly predicting RVEF decline (r = 0.7, p < 0.001).

conclusionLung resection induces substantial biventricular systolic and diastolic dysfunction, with severity proportional to resection extent. These findings highlight the utility of ERNV scanning in detecting subtle cardiac changes and emphasize the importance of preoperative cardiac evaluation to anticipate and manage postoperative complications, particularly in extensive resections like pneumonectomy.