Cardiovascular Adaptations and Complications

Abstract

Changes in right ventricular anatomy and function can occur at several stages of lung resection, starting after induction of general anesthesia and positioning, followed by one lung ventilation and surgical dissection. Compensatory mechanisms may not occur in patients with advanced COPD who are at risk of developing long-term complications. Several tests are available during the intraoperative period to evaluate right heart function and their merits are reviewed. Supraventricular arrhythmias are a common complication after thoracic surgery, depending on the side and the extent of the dissection. Atrial fibrillation is the most common postoperative rhythm disturbance after lung resection. Several pathophysiologic mechanisms as well as prophylactic and/or therapeutic maneuvers have been proposed. Older age and intrapericardial pneumonectomy are among the risk factors that strongly correlate with this condition. Acute coronary syndrome after thoracic surgery is rare but is associated with a high risk of death. Patients at risk are the ones with preoperative coronary artery disease and abnormal exercise testing. There are no clear recommendations on the role of preoperative cardiac catheterization and coronary revascularization. Cardiac failure can result from either right or left heart dysfunction, and can be transient or long standing. Symptoms may be subtle at rest and become evident during exertion. Cardiac herniation is a rare complication that may occur after intrapericardial pneumonectomy and is associated with a high mortality rate. Clinical and electrocardiographic signs are very nonspecific, and treatment is surgical. Mediastinal shift is the result of changes in the postpneumonectomy space. A high index of suspicion is needed for the diagnosis, which can present with severe hemodynamic compromise or respiratory symptoms. Postpneumonectomy syndrome may occur in the late postoperative period. It is characterized by an extreme mediastinal shift which causes dynamic compression of the distal airway and respiratory insufficiency. Treatment is surgical.