Pulmonary artery wave reflection and right ventricular function afterlung resection

Glass, A., McCall, P. , Arthur, A., Mangion, K. and Shelley, B. (2023) Pulmonary artery wave reflection and right ventricular function afterlung resection. British Journal of Anaesthesia, 130(1), e128-e136. (doi: 10.1016/j.bja.2022.07.052) (PMID:36115714) (PMCID:PMC9875909)

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Abstract

Background: Lung resection has been shown to impair right ventricular function. Although conventional measures of afterload do not change, surgical ligation of a pulmonary artery branch, as occurs during lobectomy, can create a unilateral proximal reflection site, increasing wave reflection (pulsatile component of afterload) and diverting blood flow through the contralateral pulmonary artery. We present a cardiovascular magnetic resonance imaging (MRI) observational cohort study of changes in wave reflection and right ventricular function after lung resection. Methods: Twenty-seven patients scheduled for open lobectomy for suspected lung cancer underwent cardiovascular MRI preoperatively, on postoperative Day 2, and at 2 months. Wave reflection was assessed in the left and right pulmonary arteries (operative and non-operative, as appropriate) by wave intensity analysis and calculation of wave reflection index. Pulmonary artery blood flow distribution was calculated as percentage of total blood flow travelling in the non-operative pulmonary artery. Right ventricular function was assessed by ejection fraction and strain analysis. Results: Operative pulmonary artery wave reflection increased from 4.3 (2.1–8.8) % pre-operatively to 9.5 (4.9–14.9) % on postoperative Day 2 and 8.0 (2.3–11.7) % at 2 months (P<0.001) with an associated redistribution of blood flow towards the non-operative pulmonary artery (r>0.523; P<0.010). On postoperative Day 2, impaired right ventricular ejection fraction was associated with increased operative pulmonary artery wave reflection (r=–0.480; P=0.028) and pulmonary artery blood flow redistribution (r=–0.545; P=0.011). At 2 months, impaired right ventricular ejection fraction and right ventricular strain were associated with pulmonary artery blood flow redistribution (r=–0.634, P=0.002; r=0.540, P=0.017). Conclusions: Pulsatile afterload increased after lung resection. The unilateral increase in operative pulmonary artery wave reflection resulted in redistribution of blood flow through the non-operative pulmonary artery and was associated with right ventricular dysfunction. Clinical trial registration: NCT01892800.

Item Type:Articles
Additional Information:Funding: Association for Cardiothoracic Anaesthesia and Critical Care (Project Grant 2012); National Institute of Academic Anaesthesia/Royal College of Anaesthetists British Oxygen Company Chair of Anaesthesia Research Grant to BS.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Glass, Dr Adam and McCall, Dr Philip and Shelley, Dr Benjamin and Mangion, Dr Kenneth and Arthur, Dr Alex
Authors: Glass, A., McCall, P., Arthur, A., Mangion, K., and Shelley, B.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:British Journal of Anaesthesia
Publisher:Elsevier
ISSN:0007-0912
ISSN (Online):1471-6771
Published Online:15 September 2022
Copyright Holders:Copyright © 2022 The Authors
First Published:First published in British Journal of Anaesthesia 130(1): e128-e136
Publisher Policy:Reproduced under a Creative Commons License

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