Cardiorespiratory failure in patients with pneumonectomy for tuberculosis: Long-term effects of thoracoplasty

Abstract

Twenty patients with pneumonectomy for pulmonary tuberculosis were followed for 7 to 23 years (mean 11.5 ± 4.4 years). Cardiorespiratory failure developed in 12 patients. Clinical onset of cardiorespiratory failure was found at 6 to 15 years after pneumonectomy (mean 9.1 ± 2.8 years). Eight patients were symptom free for a length of time ranging from 7 to 11 years after operation (mean 8.6 ± 1.4 years). Development of cardiorespiratory failure was significantly correlated with added thoracoplasty but was not related to age, sex, duration of tuberculosis prior to pneumonectomy, tuberculous lesions in the nonoperated lung, smoking history, or complicated pneumonia during the follow-up period. In a long pneumonectomy state, the remaining lung became hyperinflated, as indicated by increases in vital capacity and total lung capacity (per lung) as well as roentgenographic findings; however, no further deterioration of pulmonary functions developed. Added thoracoplasty might have minimized distention of the remaining lung but frequently resulted in marked scoliosis. Thoracoplasty reduced functional reserve of the lung and significantly impaired pulmonary functions. Restrictive ventilatory defect, abnormalities in ventilation-perfusion relationships and diffusing capacity on exercise, and chronic hypercarbia and hypoxemia were observed. A combination of structural, chemical, and functional changes in the lung as the result of thoracoplasty is attributed to the development of cardiorespiratory failure in patients long after pneumonectomy for pulmonary tuberculosis.