Abstract
Background: Significant pulmonary hypertension during exercise has been observed in patients with severe chronic obstructive pulmonary disease. Although favorable effects on pulmonary function and dyspnea symptoms have been demonstrated, the influence of lung volume reduction surgery (LVRS) on the pulmonary hypertension during exercise is still a controversial subject. Methods: A pulmonary function test and 6-minute walking test were performed before and 3, 6, 12 and 24 months after LVRS (n = 12). Pulmonary hemodynamics at rest and during exercise was studied 6 months after operation. Morphology was examined in pulmonary arteries with external diameters of 100 - 200 µm in the resected lung, and the wall thickness (defined as intima plus media) and percentage wall thickness (percentage wall thickness of the external diameter) of the pulmonary artery were calculated. Results: LVRS improved early-phase pulmonary function and 6-minute walking distance. Although the increase in pulmonary capillary wedge pressure during exercise was significantly ameliorated, exercise pulmonary hypertension did not change after LVRS. The percent wall thickness was highly correlated with ΔPpa (difference between mean pulmonary artery pressure at rest and mean pulmonary artery pressure during exercise) not only before, but also 6 months after LVRS. Conclusion: LVRS has no significant influence on exercise-induced pulmonary hypertension in patients with severe emphysema. From a histological analysis of the pulmonary artery in the resected lung, remodeling the pulmonary artery that may exist in the remaining lung is possibly one of the important factors preventing postoperative improvement in exercise pulmonary hypertension in patients with chronic obstructive pulmonary disease.
Key words
Lung volume reduction surgery - pulmonary hypertension - pulmonary artery remodeling
References
-
1
Cooper J D, Trulock E P, Triantafillou A N. et al .
Bilateral pneumectomy (volume reduction) for chronic obstructive pulmonary disease.
J Thorac Cardiovasc Surg.
1995;
109
(1)
106-116;discussion 116-119
-
2
McKenna R, Brenner M, Fischel R J, Gelb A F.
Should lung volume reduction for emphysema be unilateral or bilateral?.
J Thorac Cardiovasc Surg.
1996;
112
(5)
1331-1338; discussion 1338-1339
-
3
Naunheim K S, Kaiser L R, Bavaria J E. et al .
Long-term survival after thoracoscopic lung volume reduction: a multiinstitutional review.
Ann Thorac Surg.
1999;
68
(6)
2026-2031; discussion 2031-2032
-
4
Hamacher J, Russi E W, Weder W.
Lung volume reduction surgery: a survey on the European experience.
Chest.
2000;
117
(6)
1560-1567
-
5
Kubo K, Ge R L, Koizumi T. et al .
Pulmonary artery remodeling modifies pulmonary hypertension during exercise in severe emphysema.
Respir Physiol.
2000;
120
(1)
71-79
-
6
Haniuda M, Kubo K, Fujimoto K, Aoki T, Yamanda T, Amano J.
Different effects of lung volume reduction surgery and lobectomy on pulmonary circulation.
Ann Surg.
2000;
231
(1)
119-125
-
7
Kubo K, Koizumi T, Fujimoto K. et al .
Effects of lung volume reduction surgery on exercise pulmonary hemodynamics in severe emphysema.
Chest.
1998;
114
(6)
1575-1582
-
8
Shelton D M, Keal E, Reid L.
The pulmonary circulation in chronic bronchitis and emphysema.
Chest.
1977;
71
(2 suppl)
303-306
-
9
Rabinovitch M, Gamble W, Nadas A S, Miettinen O S, Reid L.
Rat pulmonary circulation after chronic hypoxia: hemodynamic and structural features.
Am J Physiol.
1979;
236
(6)
H818-827
-
10
Martinez F J, de Oca M M, Whyte R I, Stetz J, Gay S E, Celli B R.
Lung-volume reduction improves dyspnea, dynamic hyperinflation, and respiratory muscle function.
Am J Respir Crit Care Med.
1997;
155
(6)
1984-1990
-
11
Cooper J D, Patterson G A, Sundaresan R S. et al .
Results of 150 consecutive bilateral lung volume reduction procedures in patients with severe emphysema [see comments].
J Thorac Cardiovasc Surg.
1996;
112
(5)
1319-1329; discussion 1329-1330
-
12
Kotloff R M, Tino G, Bavaria J E. et al .
Bilateral lung volume reduction surgery for advanced emphysema. A comparison of median sternotomy and thoracoscopic approaches.
Chest.
1996;
110
(6)
1399-1406
-
13
Oswald-Mammosser M, Kessler R, Massard G, Wihlm J M, Weitzenblum E, Lonsdorfer J.
Effect of lung volume reduction surgery on gas exchange and pulmonary hemodynamics at rest and during exercise.
Am J Respir Crit Care Med.
1998;
158
(4)
1020-1025
-
14
Sciurba F C, Rogers R M, Keenan R J. et al .
Improvement in pulmonary function and elastic recoil after lung-reduction surgery for diffuse emphysema [see comments].
N Engl J Med.
1996;
334
(17)
1095-1099
-
15
Weg I L, Rossoff L, McKeon K, Michael G raver, Scharf S M.
Development of pulmonary hypertension after lung volume reduction surgery.
Am J Respir Crit Care Med.
1999;
159
(2)
552-556
-
16
Butler J, Schrijen F, Henriquez A, Polu J M, Albert R K.
Cause of the raised wedge pressure on exercise in chronic obstructive pulmonary disease.
Am Rev Respir Dis.
1988;
138
(2)
350-354
-
17
Powell L L, Ha H P, Serna D L. et al .
Pulmonary vascular pressures increase after lung volume reduction surgery in rabbits with more severe emphysema.
J Surg Res.
2000;
92
(2)
157-164
-
18
Wright J L, Lawson L, Pare P D. et al .
The structure and function of the pulmonary vasculature in mild chronic obstructive pulmonary disease. The effect of oxygen and exercise.
Am Rev Respir Dis.
1983;
128
(4)
702-707
-
19
Wisser W, Klepetko W, Kontrus M. et al .
Morphologic grading of the emphysematous lung and its relation to improvement after lung volume reduction surgery.
Ann Thorac Surg.
1998;
65
(3)
793-799
-
20
Brenner M, McKenna R J, Chen J C. et al .
Relationship between amount of lung resected and outcome after lung volume reduction surgery.
Ann Thorac Surg.
2000;
69
(2)
388-393
MD Masayuki Haniuda
Department of Surgery, Division of Chest Surgery, Aichi Medical University
Nagakute-Cho
Aichi 480-1195
Japan
Telefon: +81/561/623311
