Right heart function in thoracic surgery: role of echocardiography

As part of the preoperative evaluation, echocardiography provides noninvasive assessment of cardiovascular status in patients scheduled for lung resection, especially in the presence of chronic elevation of pulmonary arterial pressures. The goal of this review is to summarize the recent literature on the topic.

Changes in right ventricular function can occur acutely during lung transplantation or occasionally during lung resection. In the postoperative period, changes in right heart function will depend on preexisting pulmonary hypertension, and whether it is exacerbated by worsening chronic obstructive pulmonary disease, pneumonia or development of the adult respiratory distress syndrome. Currently, it remains controversial whether routine lung resection leads to clinically significant changes in right heart function.

The use of echocardiography in the perioperative setting can be useful in diagnosing and treating right ventricular dysfunction, especially when associated with hemodynamic instability unresponsive to conventional treatment, or arrhythmias, which all may occur after lung resection.