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The effect of lung resection on some blood circulation factors in children
Insights
Pediatric lung resection for bronchiectasis can lead to elevated pulmonary arterial pressure and worsened lung perfusion, especially after extensive surgeries. Long-term outcomes for children undergoing major lung resections remain uncertain.
Area of Science:
- Pediatric Pulmonology
- Thoracic Surgery
- Cardiopulmonary Physiology
Background:
- Bronchiectasis is a chronic lung condition requiring surgical intervention in some pediatric cases.
- Lung resection is a treatment option for severe bronchiectasis, but its long-term cardiopulmonary effects require evaluation.
Purpose of the Study:
- To assess the long-term impact of lung resection on cardiopulmonary function in children with bronchiectasis.
- To evaluate pulmonary arterial pressure, pulmonary resistance, and lung perfusion after different types of lung resections.
Main Methods:
- Cardiac catheterization, spirometry, and perfusion lung scintigraphy were performed before and 2-4 years after surgery in 18 children (aged 6-16) with bronchiectasis.
- Surgical procedures included lobectomy, bilobectomy, and pneumonectomy.
Main Results:
- Pulmonary arterial pressure remained normal after lobectomy but was elevated at rest or during exercise after pneumonectomy or bilobectomy.
- Total pulmonary resistance generally remained within normal limits, decreasing after minor resections and slightly increasing after major ones.
- Postoperative lung perfusion scintigraphy showed worsening in most children, attributed to lung tissue loss and compensatory emphysema.
Conclusions:
- Extensive lung resections in pediatric patients with bronchiectasis may lead to significant cardiopulmonary changes.
- The long-term prognosis for children with bronchiectasis undergoing extensive lung resections is uncertain, necessitating careful consideration of surgical extent.
Abstract:
Eighteen children (8 boys, 10 girls) aged 6-16 years were examined. In all of them the basic diagnosis was bronchiectasia. Catheterization of the lesser circulation global spirometric examination, and perfusion lung scintigraphy with 99mTc both before and 2--4 years after lung resection were performed. Operations performed: 14 cases of lobectomy, one of bilobectomy, three of pneumonectomy. In all of the 14 children after lobectomy the pulmonary arterial pressure remained normal even during exercise. In contrast to this, in the three children after pneumonectomy and in the one boy after bilobectomy the mean pulmonary arterial pressure exceeded 20 mmHg at rest or after exercise. The total pulmonary resistance, converted per square metre of body surface, was--with a single exception [4.7 units before surgery]--within normal limits; after minor resections it rather tended to decrease, whereas in two of four children after major resections it slightly increased. Postoperative perfusion lung scintigram revealed a worsening in comparison with the preoperative finding in practically all of the children. This worsening can be ascribed not only to the restriction of lung tissue, but also to a compensatory emphysema of the remaining parenchyma. In patients with bronchiectasia, extensive resections have uncertain long-term prognosis.