Left-Ventricular Diastolic Dysfunction during Pneumonectomy - a Transesophageal Echocardiographic Study

Left-ventricular dysfunction, with acute increase in capillary pulmonary pressure, can unexpectedly develop in patients submitted to pneumonectomy. In order to study the morphofunctional modifications induced by pneumonectomy on the left cardiac chambers, we performed intraoperative transesophageal echocardiography (TEE) in 8 patients (7 males, mean age 66 years) undergoing pneumonectomy for lung cancer. No patient had any cardiac involvement before surgery. The opening of the pericardium was associated with a slight paradoxical movement of the basal interventricular septum. After ligature of the pulmonary artery, the interventricular 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, associated with a reduced amplitude (5 patients) or an inversion (3 patients) of the second systolic component and with the development of mild mitral regurgitation (color Doppler). These changes disappeared at the end of intervention, before chest closure. No alteration in left-ventricular systolic function was found. These results suggest that the altered geometry of the interventricular septum, mainly due to acute RV overload, induces a transient left-ventricular diastolic dysfunction, associated with mild mitral regurgitation.