Pulmonary Function in the Selection of Patients for Open Heart Surgery

Abstract

Open-heart surgery provides new and definitive operations. The com plicated relationship of pulmonary function to heart disease and to pre vious thoracotomy imposes new obligations in assessing pulmonary function if further surgery is contemplated. If either initial or reopera tion is destined to failure because of coexisting and irreversible lung destruction, it is important to know it. A retrospective look at some of our successes and failures demonstrated some fallacies in our preoperative evaluation. The purpose of this dis cussion is to relate these experiences and organize the lessons we have learned. All of the patients in this study had had previous intracardiac surgery. They had either failed to improve or had deteriorated after initial im provement following that intracardiac operation. Ellis' follow-up study of our first 1,000 valvuloplasties for mitral stenosis' showed that mild to moderate mitral insufficiency did not alter the late results if mitral stenosis dominated and was corrected. However, dominant regurgitation present or produced by the initial surgery was a major cause of deteriora tion after valvuloplasty. Other patients in this study who deteriorated after initial improvement were shown at the time of re-evaluation to have recurrent stenosis. Usually this is due to an inadequate initial operation, but a small num ber have had recurrent rheumatic valvulitis. This mixed group with either borderline or frank congestive failure have been re-evaluated with a view to open-heart correction of their valvular defects. These patients had had prior left thoracotomy, were in and out of congestive failure and were known to have extensive pul monary vascular disease. It was necessary to ascertain the contribution of each lung to overall respiratory function as the original operation had been through the left hemithorax and the approach to the left atrium