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Relationship between pleural changes after myocardial revascularization and pulmonary mechanics
F S Vargas1, A Cukier, M Terra-Filho
1Instituto do Coraçao, Faculty of Medicine, University of Sao Paulo, Brazil.
Chest
|November 1, 1992
Summary
Coronary artery bypass grafting (CABG) can lead to reduced pulmonary function, especially when pleural changes occur after internal mammary artery grafting. These changes indicate greater lung function impairment, likely due to increased thoracic trauma.
Area of Science:
- Cardiothoracic Surgery
- Pulmonary Medicine
- Radiology
Background:
- Coronary artery bypass grafting (CABG) is associated with postoperative pulmonary function impairment.
- Pleural changes, such as effusion or thickening, are common after CABG.
Purpose of the Study:
- To investigate the relationship between postoperative pleural changes and pulmonary function test (PFT) results after CABG.
- To compare the impact of pleural changes in patients receiving saphenous vein graft (SVG) alone versus those receiving internal mammary artery (IMA) grafting.
Main Methods:
- Retrospective review of chest films and PFTs from 110 male patients undergoing CABG.
- Analysis of PFTs (FVC, TLC, FEV1, RV, FRC) and blood gases preoperatively and on postoperative day six.
- Stratification of patients into SVG and IMA groups, with further subgrouping based on the presence of pleural changes.
Main Results:
- In the IMA group, patients with pleural changes showed significantly greater decreases in FVC, TLC, and FEV1 compared to those without pleural changes.
- Pleural effusion and pleural thickening similarly impacted PFTs in the IMA group, with decrements significantly larger than in patients with normal radiographs.
- No significant relationship was found between pleural changes and pulmonary function decrements in the SVG group.
Conclusions:
- Postoperative pleural changes are associated with a larger decline in pulmonary function following CABG specifically in the IMA group.
- The observed pulmonary function decrement is likely attributable to increased thoracic trauma rather than the pleural changes themselves.
- Pleural changes did not significantly affect RV, FRC, Cst, or blood gases in either surgical group.