Lung function and perfusion after bronchial and pulmonary arterial sleeve resection

Area of Science:

• Thoracic Surgery
• Pulmonary Medicine
• Diagnostic Imaging

Background:

• Arterial and bronchial sleeve resections are complex thoracic procedures.
• Assessing postoperative lung function and viability is crucial after such surgeries.

Purpose of the Study:

• To evaluate the postoperative ventilatory recovery and lung viability after arterial and bronchial sleeve resections of the left upper lobe.
• To determine the effectiveness of preserved residual lung parenchyma.

Main Methods:

• Retrospective review of six patients undergoing left upper lobe sleeve resections (1985-1991).
• Preoperative and postoperative spirometry (Forced Expiratory Volume in 1 second - FEV1).
• Preoperative and postoperative pulmonary ventilation/perfusion (V/Q) scans, bronchoscopy, and serial digital vascular images (DVI) of the pulmonary artery.

Main Results:

• All patients had a patent bronchial anastomosis post-surgery.
• Postoperative DVI revealed delayed and less intense vascularization in the residual left lung in three patients.
• Postoperative V/Q scan showed reduced ventilation and perfusion in the residual lung in one patient.
• Preoperative to postoperative FEV1 showed a decline, but preserved lung function remained significant.
• Zero operative mortality; one patient experienced atelectasis.

Conclusions:

• Left upper lobe sleeve resections can lead to reduced ventilation and vascularization of the remaining lung.
• Despite imaging findings, the preserved residual lung parenchyma is considered a significant advantage.
• Sleeve resections can be performed with acceptable outcomes in selected patients.