Cardiovascular Computed Tomography Findings after Pneumonectomy

Rationale and Objectives

To identify and compare cardiovascular findings on computed tomography (CT) scans after pneumonectomy (PNX) with those after lobectomy (LOBX).

Materials and Methods

Pre- and postoperative CT scans from 25 PNX patients were retrospectively analyzed and compared to those from 30 LOBX patients. The diameter of the main pulmonary artery (PA) and its ratio to the ascending aorta (PA/Ao) were determined. Cardiac morphometry values were ascertained by measuring maximum diameters of the right and left ventricle on axial (RV axial , LV axial ) and four-chamber (RV 4-ch , LV 4-ch ) views. RV axial /LV axial and RV 4-ch /LV 4-ch ratios were calculated. Vessel stumps were evaluated for thrombosis.

Results

After PNX, PA (31.1 ± 5.8 mm vs 28.7 ± 5.4 mm, P = 0.003), PA/Ao (0.97 ± 0.15 vs 0.86 ± 0.12, P = 0.0001), and cardiac morphometry values significantly increased (RV axial 43.6 ± 7.4 vs 39.4 ± 7.1, P = 0.029; RV 4-ch 41.1 ± 6.3 vs 37.6 ± 5.7, P = 0.041; RV axial /LV axial 1.18 ± 0.27 vs 1.03 ± 0.22, P = 0.04; RV 4-ch /LV 4-ch 1.17 ± 0.21 vs 1.02 ± 0.16, P = 0.03). There were no significant differences between right and left PNX. One case of PA stump thrombosis was identified after right PNX. LOBX resulted in a significant increase in PA (30.6 ± 4.3 vs 28.7 ± 3.5, P = 0.005) and PA/Ao (0.90 ± 0.09 vs 0.85 ± 0.10, P = 0.017), whereas cardiac morphometry values were not significantly changed compared to baseline values. No vessel stump thrombosis was observed after LOBX. In comparison to LOBX, all ascertained values were significantly elevated after PNX.

Conclusions

Morphologic alterations of the cardiovascular system following PNX can be identified on CT scans. Alterations are more distinct after PNX compared to LOBX.

Introduction

Pneumonectomy (PNX) has various early and late effects on the cardiovascular system that are based on displacement of the heart and major vessels , altered hemodynamics in vessel stumps , increased perfusion to the remaining lung tissue , and elevated vascular resistance . In about 40% of patients after PNX these effects were shown to induce pulmonary hypertension (PH), that is, resting mean pulmonary artery pressures (PAP) exceeding 25 mmHg with concomitant dysfunction and remodeling of the right ventricle .

Doppler echocardiography was found to be useful in the evaluation of patients undergoing PNX as the right ventricular function and morphology as well as PAP can be assessed noninvasively .

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Materials and Methods

Data Analysis

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Table 1

Patients’ Characteristics

Pneumonectomy LobectomyMale 17 17Female 8 13Mean age at surgery (range) 61.3(40–73) 64.3(46–81)Right 11 Upper lobe 14

Lower lobe 2

Middle lobe 4Left 14 Upper lobe 6

Lower lobe 4Indication Bronchogenic carcinoma 19 25 Metastases from extrapulmonary malignancy 2 3 Pleural empyema 1 — Bleeding from pulmonary artery aneurysm — 1 Tuberculosis 1 — Bronchial carcinoid tumor 1 1 Lung abscess 1 —

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Thoracic Vessels

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Cardiac Morphometry

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Statistics

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Results

PNX

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Table 2

Morphometric Data Before and After PNX

Before PNX After PNX_P_ Value Interobserver Agreement Bias \* 95% Limits of Agreement † PA [mm] 28.7 ± 5.4 31.1 ± 5.8 0.003 −0.062 [−0.63, 0.50] PA/Ao 0.86 ± 0.12 0.97 ± 0.15 0.0001 −0.003 [−0.06, 0.05] RV axial [mm] 39.4 ± 7.1 43.6 ± 7.4 0.029 0.052 [−0.53, 0.63] RV 4-ch [mm] 37.6 ± 5.7 41.1 ± 6.3 0.041 −0.130 [−0.83, 0.57] RV axial /LV axial 1.03 ± 0.22 1.18 ± 0.27 0.04 −0.010 [−0.07, 0.05] RV 4-ch /LV 4-ch 1.02 ± 0.16 1.17 ± 0.21 0.03 −0.039 [−0.11, 0.03]

Ao, diameter of the ascending aorta; LV 4-ch , left ventricular diameter in four-chamber view; LV axial , left ventricular diameter on axial sections; PA, pulmonary artery diameter; PNX, pneumonectomy; RV 4-ch , right ventricular diameter in four-chamber view; RV axial , right ventricular diameter on axial sections.

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Right PNX Versus Left PNX

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Table 3

Morphometric Data of Patients Who Underwent Right or Left PNX

After Right PNX After Left PNX_P_ Value PA [mm] 31.6 ± 5.4 34.1 ± 5.8 ns PA/Ao 0.99 ± 0.15 0.99 ± 0.14 ns RV axial [mm] 41.4 ± 8.4 42.3 ± 7.8 ns RV 4-ch [mm] 38.1 ± 5.4 41.6 ± 1.1 ns RV axial /LV axial 1.12 ± 0.17 1.20 ± 0.33 ns RV 4-ch /LV 4-ch 1.12 ± 0.13 1.16 ± 0.25 ns PA stump length [mm] 31.5 ± 12.0 12.9 ± 9.5 <0.0001

Ao, diameter of the ascending aorta; LV 4-ch , left ventricular diameter in four-chamber view; LV axial , left ventricular diameter on axial sections; ns, not significant; PA, pulmonary artery diameter; PNX, pneumonectomy; RV 4-ch , right ventricular diameter in four-chamber view; RV axial , right ventricular diameter on axial sections.

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LOBX

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Table 4

Morphometric Data of Patients Before and After LOBX

Before LOBX After LOBX_P_ Value Interobserver Agreement Bias \* 95% Limits of Agreement † PA [mm] 28.7 ± 3.5 30.6 ± 4.3 0.005 −0.005 [−0.59, 0.58] PA/Ao 0.85 ± 0.10 0.90 ± 0.09 0.017 −0.020 [−0.08, 0.04] RV axial [mm] 38.0 ± 6.9 38.5 ± 5.5 ns −0.120 [−0.70, 0.46] RV 4-ch [mm] 36.0 ± 7.5 37.0 ± 5.5 ns −0.035 [−0.54, 0.47] RV axial /LV axial 0.94 ± 0.15 0.99 ± 0.16 ns 0.007 [−0.03, 0.04] RV 4-ch /LV 4-ch 0.93 ± 0.18 0.99 ± 0.24 ns 0.008 [−0.04, 0.05]

Ao, diameter of the ascending aorta; LOBX, lobectomy; LV 4-ch , left ventricular diameter in four-chamber view; LV axial , left ventricular diameter on axial sections; ns, not significant; PA, pulmonary artery diameter; RV 4-ch , right ventricular diameter in four-chamber view; RV axial , right ventricular diameter on axial sections.

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PNX Versus LOBX

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Table 5

Morphometric Data of Patients Before and After PNX or LOBX

Before Surgery After Surgery PNX LOBX_P_ Value PNX LOBX_P_ Value PA [mm] 28.7 ± 5.4 28.7 ± 3.5 ns 31.1 ± 5.8 30.6 ± 4.3 0.045 PA/Ao 0.86 ± 0.12 0.85 ± 0.10 ns 0.99 ± 0.14 0.90 ± 0.09 0.014 RV axial [mm] 39.4 ± 7.1 38.0 ± 6.9 ns 43.6 ± 7.4 38.5 ± 5.5 0.011 RV 4-ch [mm] 37.6 ± 5.7 36.0 ± 7.5 ns 41.1 ± 6.3 37.0 ± 5.5 0.002 RV axial /LV axial 1.03 ± 0.22 0.94 ± 0.15 ns 1.18 ± 0.27 0.99 ± 0.16 0.003 RV 4-ch /LV 4-ch 1.02 ± 0.16 0.93 ± 0.18 ns 1.17 ± 0.21 0.99 ± 0.24 0.004

Ao, diameter of the ascending aorta; LOBX, lobectomy; LV 4-ch , left ventricular diameter in four-chamber view; LV axial , left ventricular diameter on axial sections; ns, not significant; PA, pulmonary artery diameter; PNX, pneumonectomy; RV 4-ch , right ventricular diameter in four-chamber view; RV axial , right ventricular diameter on axial sections.

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Discussion

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Cardiovascular Computed Tomography Findings after Pneumonectomy

Rationale and Objectives

Materials and Methods

Results

Conclusions

Introduction

Materials and Methods

Data Analysis

Thoracic Vessels

Cardiac Morphometry

Statistics

Results

PNX

Right PNX Versus Left PNX

LOBX

PNX Versus LOBX

Discussion

References

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