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Mechanisms of right ventricular dysfunction after pulmonary resection
C E Reed1, B H Dorman, F G Spinale
1Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston 29425, USA.
The Annals of Thoracic Surgery
|July 1, 1996
Summary
Right ventricular (RV) dysfunction after pulmonary resection is not due to changes in contractility or afterload. Controlling heart rate may improve RV pump function post-surgery.
Area of Science:
- Cardiology
- Thoracic Surgery
- Physiology
Background:
- Right ventricular (RV) dysfunction is common after pulmonary resection, characterized by increased end-diastolic volume and reduced ejection fraction.
- The study investigates whether altered RV contractile state or afterload contributes to this postoperative dysfunction.
Purpose of the Study:
- To determine the causes of right ventricular (RV) pump dysfunction following pulmonary resection.
- To assess the roles of RV contractility and afterload in RV dysfunction post-surgery.
Main Methods:
- RV contractility was assessed using the preload recruitable stroke work relation, comparing pre-operative and post-operative measurements.
- RV afterload was manipulated with prostaglandin E1 infusion post-operatively to evaluate its effect on RV pump function.
Main Results:
- No significant changes in RV contractile state were observed between pre-operative and post-operative periods.
- Reducing pulmonary vascular resistance with prostaglandin E1 did not improve RV ejection fraction, which remained significantly reduced.
- Postoperative RV dysfunction was associated with increased end-diastolic volume and heart rate.
Conclusions:
- Right ventricular (RV) dysfunction after pulmonary resection is not primarily caused by alterations in contractility or immediate afterload changes.
- Optimizing heart rate control with minimal impact on contractility may be a strategy to enhance RV pump function post-pulmonary resection.