Pulmonary Resection

Physiology

  • Development of Post-Op Pulmonary HTN due to resection of lung tissue/vessels
    • At least 66% of lung tissue must be removed to produce pulmonary HTN in normal lungs (demonstrated in animal studies)

Diagnosis

PFT’s:

CXR: enlarged PA (right PA >16mm)/ “pruned tree” pulmonary vasculature/ enlarged SVC, azygous vein/ enlarged RV (loss of retrosternal air space)
V/Q scan: useful to exclude acute PE/ chronic thromboembolic disease
Pulmonary angiogram: useful to define anatomy and to exclude CTEPH

EKG: RVH with RAD/P-pulmonale

ECHO: RVE with often decreased RV-EF/ TR/ PR/ normal LV-EF
-Doppler: quantification of TR jet allows estimation of PA pressure
-Bubble study: may be useful to exclude intracardiac shunt (VSD/ ASD/ etc.)

SWAN:
-RA: normal (at rest)
-RV-SYS: elevated (with normal RV-EDP)
-PA-SYS: mild-moderately ele-vated (PA-SYS usually <30-50 mm Hg in COPD)
-PA-DIA: usually elevated
-PA-MEAN: mild-moderately elevated
-PCWP: normal (reflects normal LA and LV-EDP)
-CO: normal at rest (does not rise appropriately with exercise)

CATH: useful to exclude intracardiac shunt


Clinical Presentations

  • Pulmonary Hypertension (see [[Pulmonary Hypertension]])

References

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