LEFT-VENTRICULAR DIASTOLIC DYSFUNCTION DURING PNEUMONECTOMY - A TRANSESOPHAGEAL ECHOCARDIOGRAPHIC STUDY

Left-ventricular dysfunction, with acute increase in capillary pulmona ry pressure, can unexpectedly develop in patients submitted to pneumon ectomy. In order to study the morphofunctional modifications induced b y pneumonectomy on the left cardiac chambers, we performed intraoperat ive transesophageal echocardiography (TEE) in 8 patients (7 males, mea n age 66 years) undergoing pneumonectomy for lung cancer. No patient h ad any cardiac involvement before surgery. The opening of the pericard ium was associated with a slight paradoxical movement of the basal int erventricular septum. After ligature of the pulmonary artery, the inte rventricular septum changed its geometry, losing the normal curvature and becoming rectilinear. These changes were related to an increase in right-ventricular (RV) dimensions. In all patients the pulmonary vein flow-profile (pulsed Doppler) showed an increased turbulence, associa ted with a reduced amplitude(5 patients) or an inversion (3 patients) of the second systolic component and with the development of mild mitr al regurgitation (color Doppler). These changes disappeared at the end of intervention, before chest closure. No alteration in left-ventricu lar systolic function was found. These results suggest that the altere d geometry of the interventricular septum, mainly due to acute RV over load, induces a transient left-ventricular diastolic dysfunction, asso ciated with mild mitral regurgitation.