Postoperative Pulmonary Function Tests Research Articles

Complicações relacionadas à lobectomia em doadores de transplante pulmonar intervivos

To evaluate post-operative complications in living lobar lung transplant donors. Between September of 1999 and May of 2005, lobectomies were performed in 32 healthy lung transplant donors for 16 recipients. The medical charts of these donors were retrospectively analyzed in order to determine the incidence of postoperative complications and alterations in pulmonary function after lobectomy. Twenty-two donors (68.75%) presented no complications. Among the 10 donors presenting complications, the most frequently observed complication was pleural effusion, which occurred in 5 donors (15.6% of the sample). Red blood cell transfusion was necessary in 3 donors (9.3%), and 2 donors underwent a second surgical procedure due to hemothorax. One donor presented pneumothorax after chest tube removal, and one developed respiratory infection. There were two intra-operative complications (6.25%): one donor required bronchoplasty of the middle lobe; and another required lingular resection. No intra-operative mortality was observed. Post-operative pulmonary function tests demonstrated an average reduction of 20% in forced expiratory volume in one second (p < 000.1) compared to pre-operative values. Lobectomy in living lung transplant donors presents high risk of post-operative complications and irreversible impairment of pulmonary function. Careful pre-operative evaluation is necessary in order to reduce the incidence of complications in living lobar lung transplant donors.

Prospective Pulmonary Function Comparison Following Posterior Segmental Spinal Instrumentation and Fusion of Adolescent Idiopathic Scoliosis

Prospective clinical study. To investigate if a correlation exists between various parameters including major thoracic curve correction and postoperative pulmonary function test (PFT) improvement at 2 years postoperative following posterior segmental spinal fusion (PSSF) and instrumentation with iliac crest bone graft (ICBG). There are no studies available on the correlation between major thoracic curve correction and postoperative PFT improvement following PSSF and instrumentation with ICBG with a homogenous diagnosis, similar operation method, and similar age population. One hundred thirty-nine patients with adolescent idiopathic scoliosis (Lenke type 1-4), undergoing PSSF and instrumentation with ICBG at a single institution, were before surgery and 2 years after surgery prospectively evaluated in regard to PFTs, assessing forced vital capacity, and forced expiratory volume in 1 second. PFTs change at 2 years postoperative was compared by the various parameters including major thoracic Cobb curve correction and the types of instrumentation. We defined a significant clinical improvement as a 10% or more increase of percent predictive FEV1 value at 2 years postoperative. PSSF and instrumentation with ICBG demonstrated statistically significant improvement of absolute and percent-predicted PFTs at 2 years postoperative. There was a significant clinical improvement in 31 patients (22%) at 2 years postoperative. Significant clinical improvement was related to thoracic pedicle screw instrumentation (vs. thoracic hook instrumentation, P = 0.030). Absolute amount of major thoracic Cobb correction, magnitude of the residual curve, correction percentage of the major thoracic Cobb, the number of fused vertebrae, Risser sign, and age at surgery did not demonstrate any significant positive or negative correlation (-0.3 <Pearson correlation coefficient <0.3). Patients having a PSSF and instrumentation with ICBG statistically significant improvement of absolute and percent-predicted PFTs at 2 years postoperative. There was a significant clinical improvement in 31 patients (22%) at 2 years postoperative. A significant clinical improvement was related with thoracic pedicle screw instrumentation.

Usefulness of Lung Perfusion Scintigraphy Before Lung Cancer Resection in Patients with Ventilatory Obstruction

The study was conducted to evaluate the efficacy of preoperative lung perfusion scintigraphy performed by planar acquisition and single-photon emission computed tomography (SPECT) in predicting postoperative pulmonary function of patients with resectable lung cancer and obstructive ventilatory defect. The study enrolled 39 patients (mean age, 67 +/- 2.1 years). All patients underwent preoperative and postoperative pulmonary function tests. Cut-off values for postoperative forced expiratory volume in 1 second (FEV1) were 65% of the predicted value for pneumonectomy and 45% for lobectomy. A semiquantitative analysis of planar and SPECT lung perfusion scintigraphy images was performed preoperatively to estimate postoperative predicted FEV1 (FEV1ppo). Relationships between FEV1ppo and measured postoperative FEV1 were tested by the Pearson correlation and Bland Altman agreement tests. Twenty-eight lobectomies and 11 pneumonectomies were performed. The FEV1ppo estimated by mean planar lung scintigraphy was 1.85 +/- 0.38 L, with a Pearson correlation coefficient to the measured FEV1 of 0.8632 (p < 0.001). The mean FEV1ppo estimated by SPECT was 1.78 +/- 0.31 L, with a Pearson coefficient to the measured FEV1 of 0.8527 (p < 0.001). Both values showed a more significant correlation with postoperative measured FEV1 after lobectomy (p < 0.001) than after pneumonectomy (p = 0.045). The Bland Altman test confirmed satisfactory agreement of FEV1ppo estimated by both planar lung scintigraphy and SPECT with FEV1 measured by spirometry. Both planar lung scintigraphy and SPECT can accurately predict postoperative FEV1 and can therefore be considered reliable tools in establishing operability of patients with lung cancer and ventilatory obstruction.

Comparison of pre‐ and postoperative pulmonary function in obese and non‐obese female patients undergoing coronary artery bypass graft surgery

Various studies have suggested that body size and in-hospital mortality are related. However, only a few analysed the effects of obesity on pulmonary complications following coronary artery bypass graft surgery (CABG). The purpose of the present study was to assess early changes in lung volumes, respiratory complications and arterial blood gas tension following CABG in obese women. Pulmonary function tests (PFTs), treadmill exercise capacity tests (TM), arterial blood gases and pulmonary complications were studied in 124 obese (mean age 57.2+/-5.8 years) and 108 non-obese (mean age 58.6+/-5.9 years) female patients undergoing elective CABG. PFT, TM tests, arterial blood gas analyses and CXR were performed in the preoperative and postoperative periods and pulmonary complications were recorded. Breathing and coughing exercises, early ambulation and pulmonary clearing techniques were used by physical therapists to prevent pulmonary complications after CABG surgery. Postoperative PFT and TM tests deteriorated significantly in both groups (P<0.0001). The deterioration in the obese group was highly significant. The postoperative deterioration of blood gas measurements in obese patients was also statistically significant compared to non-obese patients. Early pulmonary complications developed in 21 (16.94%) of the obese patients and in 10 (9.25%) of non-obese patients. Duration of mechanical ventilation, intensive care unit and hospital stays were longer compared to the non-obese patients (P=0.008, P<0.0001, P=0.0386, respectively). Obesity has a detrimental effect on pulmonary function, exercise capacity, blood gas measurements and complications rates in postoperative period following CABG surgery.

Modified needlescopic video-assisted thoracic surgery for primary spontaneous pneumothorax

The objective of this study was to evaluate the feasibility and safety of modified needlescopic video-assisted thoracic surgery (VATS) for treating primary spontaneous pneumothorax. The efficacy between apical pleurectomy and pleural abrasion through this technique was also compared. Between 2001 and 2003, 65 patients with primary spontaneous pneumothorax underwent modified needlescopic VATS procedures. The blebs were resected with endoscopic linear staplers. Pleurodesis was achieved by apical pleurectomy before September 2002 (n = 30) and by pleural abrasion for the remainder of the study period (n = 35). Mean operation time was 103 min in the pleurectomy group and 78 min in the abrasion group (p = 0.001). Complications developed in four patients (6.2%): prolonged air leaks in three patients and wound infection in one patient. The mean postoperative hospital stay was 3.8 +/- 1.8 days. The two groups had comparable doses of requested analgesics, complication rates, postoperative chest tube and hospital stays, and postoperative pulmonary function test. Ipsilateral recurrence did not occur in any of the pleurectomy group patients after a mean follow-up of 31 months, but it occurred in three patients (8.6%) in the abrasion group after a mean follow-up of 19 months. Modified needlescopic VATS provides a feasible and safe procedure for treating primary spontaneous pneumothorax. In terms of efficacy, apical pleurectomy is more effective in preventing ipsilateral recurrence than pleural abrasion.

The Effect of Scoliosis Surgery on Lung Function in the Immediate Postoperative Period

Prospective, single-cohort study. To determine the immediate change in pulmonary function test (PFT) in children following scoliosis surgery. The number of pediatric scoliosis surgeries is increasing each year because of recent advances in spinal instrumentation, surgical techniques, and improved perioperative monitoring. Pulmonary function decreases immediately following scoliosis surgery, but the extent of this decrease is not well documented in pediatric patients. To use preoperative PFTs to assess the risk of postoperative complications, knowledge of the postoperative decline in PFT is necessary. We measured preoperative and daily postoperative PFT in 24 children who had scoliosis surgery (age 12.7 +/- 2.7 [SD] years) from January 2002 to June 2003. There were 10 male and 14 female patients. Two (8%) patients had congenital scoliosis, 11 (46%) had idiopathic scoliosis, 9 (38%) had scoliosis due to a neuromuscular disease, and 2 (8%) had kyphoscoliosis. Fifteen (62%) patients had posterior spinal fusion (PSF), 5 (21%) had anterior spinal fusion (ASF), and 4 (17%) had both ASF and PSF performed. PFT parameters (forced expiratory volume in 1 second [FEV1], forced vital capacity [FVC], FEV1/FVC, and forced expiratory rate between 25% and 75% of FVC [FEF25%-75%]) were measured before surgery and daily after surgery by bedside spirometry until hospital discharge. PFT declined up to 60% after surgery. The PFT nadir is at 3 days. PFT values remained significantly decreased at 1 week, with values at about half of preoperative baseline. No patient required postoperative mechanical ventilation > or =3 days. There was no statistical significance between the degree of decline in PFT with etiology of either the scoliosis or the type of surgery performed. Our study found that patients are still at risk for postoperative complications as long as 1 week postoperatively and that PFTs do not return to near baseline until 1 to 2 months after surgery. The postoperative decrease in PFT should be considered during preoperative prediction of postoperative risk.

Thoracic surgery in children

Children rarely undergo thoracic surgery. When they do, the procedures fall into five main groups: oncologic indications, immune defects, malformations, infections and trauma. In addition to considerations associated with the underlying indication, the different proportions of the anatomical structures in children require special modifications in both diagnostics and surgical technique compared to corresponding procedures in adults. Of a total 2137 thoracic surgical procedures performed between 1992 and 2001, 49 were performed in children (n = 37; age: 3 months-15 years; median age: 8 years). Indications for surgery included underlying oncologic disease (n = 20), immunodeficiency (n = 5), thoracic or pulmonary malformation (n = 6) and trauma (n = 3). Patients' postoperative clinical course was analyzed retrospectively for all 49 procedures. Pre- and postoperative pulmonary function test results are available for 16 children. Data regarding quality of life were documented in 24 children. The following procedures were performed: 27 atypical resections, seven lobectomies, one pneumonectomy, three decortications, four mediastinotomies or mediastinoscopies and seven other procedures. Six procedures represented second or third procedures in the same patient. Two of six patients with immune defects died during the perioperative period. Eleven of 20 oncologic patients (55%) have remained free of recurrent disease. Quality of life, as assessed by the Karnowski index in 24 children, was at least 80%. Thoracic surgical procedures in children with underlying benign disease are associated with a good prognosis and high quality of life scores. Surgical treatment of pulmonary metastases is a feasible component of the overall oncologic therapy concept and can offer the only opportunity for curation for a selected group of patients. Because of high postoperative mortality, however, the indication for diagnostic thoracotomies in children with immunodeficiencies and poor general health should be weighed critically.

Thoracic Epidural Versus Intercostal Nerve Catheter Plus Patient-Controlled Analgesia: A Randomized Study

Pain control is an important issue after thoracotomy. Ideal methods should have a high success rate, with easy implementation and minimal complications. Debate exists over the optimal pain control method. This randomized trial was designed to compare epidural (EPI) and intercostal nerve catheter with patient-controlled analgesia (ICN-PCA) for pain control after thoracotomy. The study included 124 randomized patients; 91 had sufficient data for analysis (44 EPI, 47 ICN-PCA). The primary endpoint was pain measurement using a composite of a visual analogue scale, numerical rating, and categorical rating. A second endpoint was the success rate of each method. Pulmonary function tests, antibiotics, intensive care unit (ICU), and hospital days, and use of nonprotocol pain medications were also compared. There were 12 pain observations per patient (90% completed on days 1 to 5). The pain composite revealed an average postoperative pain score of 2.4 on a scale from 0 (no pain) to 10 (worst pain). There was no difference between the groups. Failures of the planned method of analgesia included 9 in the EPI group and 4 in the ICN group (p = 0.23). Another 20 patients were excluded (no difference between groups) due to unsuspected mediastinal metastases precluding thoracotomy (n = 13), and other miscellaneous factors precluding follow-up (n = 7). The EPI group had an increased number of urinary catheter days (2.5 days vs 1.7, p = 0.002) and increased narcotic supplements (p = 0.03) compared with ICN. Mean ICU days (0.9) and hospital days (6.2) were similar for both groups, and there were no differences in arrhythmias, pneumonias, transfusions, and antibiotic use. Significant differences were seen (p = 0.001) between preoperative and postoperative pulmonary function tests in both groups. However, there were no differences in pulmonary function when the groups were compared with each other. Satisfactory pain control was achieved after thoracotomy using either EPI or ICN-PCA. The ICN-PCA achieved equivalent pain control compared with EPI, and was placed by the surgeon with no delays in surgery, and demonstrated a decreased requirement for Foley catheter duration.

Chronic tuberculous empyema: relationships between preoperative CT findings and postoperative improvement measured by pulmonary function testing

To evaluate whether preoperative computed tomography (CT) findings correlate with postoperative improvements in forced vital capacity (FVC) and forced expiratory volume during 1s (FEV1) in persons who have undergone unilateral decortication because of unilateral chronic tuberculous empyema. A retrospective study was carried out of 67 individuals who had undergone decortication because of chronic tuberculous empyema between January 1996 and December 2000. Of these, 13 subjects who had had preoperative chest CT and preoperative and postoperative pulmonary function tests (PFTs) were included in the investigation. On preoperative CT, the degree of volume reduction of the affected side was compared with that of the contralateral normal lung. The relative volume of empyema was calculated by dividing the volume occupied by the empyema by the sum of the total volume of the ipsilateral lung and the empyema volume. The thicknesses of pleura and extrapleural fat in the involved hemithorax were measured by CT at their thickest points, and the degree of atelectasis adjacent to the empyema in the diseased lung was assessed and classified. These five CT parameters and the ages of the patients were compared with preoperative and postoperative FVC and FEV1 changes. A significant negative correlation was found between FVC changes and the relative volume of the affected lung (FVC: p = 0.039, RS = -0.58). FVC and FEV1 were found to be significantly and positively correlated with the relative volume of the empyema (FVC: p = 0.005, RS = 0.72; FEV1: p = 0.014, RS = 0.66) and the degree of atelectasis (FVC: p = 0.007, RS = 0.71; FEV1: p = 0.029, RS = 0.60) by Spearman's nonparametric correlation test. Other CT parameters and the ages of the patients were not found to be correlated with PFT changes. The relative volume of the affected side, the relative volume of empyema and the degree of atelectasis can predict improvements in FVC and FEV1 after decortication in patients with chronic tuberculous empyema.

A model to predict the decline of the forced expiratory volume in one second and the carbon monoxide lung diffusion capacity early after major lung resection

The objective of the study was to develop regression models for the prediction of the decline of the forced expiratory volume in one second (FEV1) and the carbon monoxide lung diffusion capacity (DLCO) early after major lung resection. One hundred and ninety patients submitted to pulmonary lobectomy or pneumonectomy for lung cancer performed preoperative and early postoperative (mean 10.9 after operation) pulmonary function tests. One hundred and fifty of these patients also underwent DLCO measurements by the single breath method. The decline of FEV1 and DLCO were expressed as percentage losses from preoperative values. Stepwise multiple regression analyses were performed to develop two models estimating the percent reduction of FEV1 and DLCO from preoperative values. The multivariate procedures were then validated by bootstrap analyses. The following regression equations were derived: estimated percent reduction in FEV1 = 21.34 - (0.47 x age) + (0.49 x percentage of functioning parenchyma removed during operation) + (17.91 x COPD-index); estimated percent reduction in DLCO = 35.99 - (0.31 x age) - (36.47 x FEV1/FVC ratio) + (0.33 x DLCO) + (0.54 x percentage of functioning parenchyma removed during operation). The comparison between observed and estimated losses of FEV1 and DLCO (by using these regression equations) was not significantly different. We think the regression models generated in this study may be reliably used for risk stratification purposes.

Off-pump versus on-pump coronary artery bypass surgery and postoperative pulmonary dysfunction

Objective : To investigate how off-pump coronary artery bypass grafting (CABG) affects postoperative pulmonary function when compared with on-pump CABG. Design : Prospective clinical study. Setting : University-affiliated teaching hospital. Participants : Adult patients (n = 39) undergoing elective coronary artery bypass surgery with or without cardiopulmonary bypass. Interventions : Two groups of patients were compared: 19 consecutive patients undergoing off-pump CABG surgery and 20 consecutive patients undergoing conventional CABG surgery. Measurements and Main Results : Pulmonary function tests (flow volume loops and lung volumes with plethysmography) were done preoperatively and 72 hours postoperatively. Arterial blood gases and PaO 2/F IO 2 were measured at various stages. Sequential chest x-rays were obtained and evaluated for pleural changes, pulmonary edema, and atelectasis. In both groups, PaO 2/F IO 2 ratios decreased progressively throughout the perioperative period, with no significant differences between the groups at any stage during the study. There was a significant decline in postoperative pulmonary function tests in both groups, but there was no difference between groups at 72 hours postoperatively. No differences were found in the time to extubation, atelectasis scores, or postoperative complications. Conclusions : Off-pump CABG does not confer major protection from postoperative pulmonary dysfunction compared with CABG surgery with CPB. Strategies for minimizing pulmonary impairment after CABG surgery should be directed to factors other than the use of CPB.

Early changes in pulmonary function following thoracotomy for scoliosis correction: the effect of size of incision

The authors have decided to tackle the old belief that the smaller the thoracotomy incision—or the less invasive the spine surgery—the better the pulmonary function will be. In their study it is very clear that the only difference noticed between their two identical groups of patients treated with conventional thoracotomy (group A) and the minimal access thoracotomy (group B) is a change in the early postoperative pulmonary function test at 2 weeks. At 3 months no difference could be observed in terms of functional vital capacity and forced expiratory volume. Unfortunately, no data is given for 1-year or 2-year follow-ups, but common sense and literature review should predict that no difference should be observed between their two groups. These findings contradict the proponents of minimal thoracotomy, who argue that minimal access surgery will result in far less trauma to the chest. Newton has shown that a group with thoracoscopic-instrumented scoliotic spine has less decrease in pulmonary function than the open-thoracotomy group, although the difference tends to diminish with time [1]. Newton’s findings would, therefore, prove that thoracoscopic instrumentation is less aggressive for the lung, initially, than classic open thoracotomy. However, the paper currently published deals with minimal open thoracotomy vs conventional thoracotomy. One can argue that one long incision of 15–20 cm (conventional thoracotomy) may seem to be equivalent to a few small incisions (two or three 7.5 cm-long incisions) or multiple thoracoscopic incisions (five to six, in the case of thoracoscopic anterior release). The required retraction and subsequent trauma to the chest to approach several thoracic levels should be compared with the trauma of multiple, small thoracotomies or small thoracoscopic incisions. The limits of the study are that the author does not furnish other factors besides respiratory function, such as the amount of postoperative pain observed in the two groups, amount of blood loss (intraoperative and postoperative in the chest tube), surgical time difference between the two groups, possible complications in each group, and the outcome differences of the two groups. Consequently, we do not know from this study whether it is worth doing these thoracotomies in a minimal-access fashion. The other limit is that both groups underwent anterior rib-head excision and posterior spinal instrumentation with costectomies. This rib excision may be considered even more aggressive than the anterior thoracotomy and may induce flaws and account for the similar results on the pulmonary function tests at the 3-month follow-up. The principal criticism of this paper concerns the indications for such an aggressive method of treatment for moderate-size curves in the adolescent age group. The mean age (15 years old) and Cobb angle (60°) of the patients reported in this series are similar to other numerous series. However, most adolescent thoracic scoliosis cases can be treated with either a simple anterior or a posterior surgery and do not require such an aggressive circumferential surgery. Doing an anterior release with rib-head excision, followed 2 weeks later by a posterior instrumentation including posterior costectomies is far from standardized surgery in adolescent idiopathic surgery. The age group of the patients (15 years old) does not justify the need for an anterior release to prevent crankshaft. Most of the patients in the study appear to be normokyphotic (average preoperative kyphosis 21°) and, therefore, do not require anterior release. All patients had posterior costectomies, which is not always justified in this age group. The sequence of anterior release followed 2 weeks later by posterior instrumentation can only be justified if resources limit access to postoperative ICU and for very large curves (superior to 100°) that would require halo traction between the two stages. Therefore, the authors have only proven that there is no significant change in pulmonary function between conventional thoracotomy and minimal access thoracotomy at 3 months for their sequence of treatment. Such sequence (anterior release with rib-head excision, followed 2 weeks later by posterior instrumentation and posterior costectomies) for moderate thoracic curves cannot serve as a reference for the general spinal deformity surgeon community.

Effects of smoking on pulmonary functions and arterial blood gases following coronary artery surgery in Turkish patients.

The effects of smoking on postoperative lung volumes, arterial blood gas tensions, and pulmonary complications were studied prospectively in 213 consecutive Turkish patients undergoing elective coronary artery bypass graft surgery. One hundred and seventeen patients were current smokers (19 females, 98 males, mean age. 59.0 +/- 6.1 years. group 1) and 96 were nonsmokers (40 females, 56 males mean age. 59.6 +/- 5.8 years, group 2). Demographic data and the anesthesia and surgical methods were similar in both groups. Pulmonary function tests, arterial blood gas analyses, and chest radiographs were done preoperatively and postoperatively. Pulmonary complications were recorded. Postoperative partial arterial oxygen tension values in both groups revealed moderate hypoxemia which was more intense in smokers (decreased from preop. 82.0 +/- 7.8 mmHg to postop. 66.1 +/- 8.0 mmHg). Mean partial carbon dioxide tension increased significantly, remaining within acceptable limits (from 32.5 +/- 2.2 mmHg to 38.6 +/- 3.6 mmHg) in smokers following surgery. The postoperative pulmonary function test values decreased significantly in both groups but the deterioration in the smoking group was highly significant, except for FMFT. In the smokers, the preoperative mVC/pFVC (%) value was at the lower normal limit which indicates slight restrictive respiratory problems. Patients in both groups developed a severe restrictive ventilatory defect after coronary artery surgery (P < 0.0001 for both), but this restriction was also statistically significant in the smoking group compared to nonsmokers after surgery (mVC/pFVC from 74.7 +/- 12.6% to 52.3 +/- 10.0% and 80.8 +/- 13.5% to 63.2 +/- 10.7%. in the smokers and nonsmokers, respectively). Also, the significantly greater decrease in the FEV1/FVC ratio in the smokers (from 75.4 +/- 12.2% to 72.2 +/- 11.5%) (P = 0.037) was indicative of greater airway obstruction. Pulmonary complications developed in 20.5% (24 people) of the smokers and 10.4% (10 people) of the nonsmokers. The mean time to extubation, intensive care unit stay, and hospital stay for groups 1/2 were 19.9 +/- 11.5/14.1 +/- 4.3 hours (P < 0.0001) 3.2 +/- 1.3/2.4 +/- 0.6 days (P < 0.0001), and 14.1 +/- 4.4/12.5 +/- 2.4 days (P = 0.0013), respectively. For the male group, we obtained results similar to those for the whole (males + females) study population and concluded that the observed differences in various parameters between smokers and nonsmokers were not due to gender. As a result. we revealed that cigarette smoking affects pulmonary functions by causing obstructive type respiratory problems and by worsening existing restrictive type respiratory problems postoperatively. The postoperative deterioration in blood gas measurements of smokers was also statistically significant compared with nonsmokers. In addition, the incidence of pulmonary complications in smokers was 2-fold greater than in nonsmokers and was related to the number of cigarettes consumed daily, leading to prolongation of the postoperative intubation period, and ICU and hospital stays.

Left ventricular outflow tract pseudoaneurysms in congenital heart disease

complications of surgical and Amplatzer device closure of atrial septal defects. J Thorac Cardiovasc Surg 1999;118:674–680. 3. Sievert H. Interventional versus surgical closure of atrial and ventricular septal defects: advantages and limitations of the catheter-based approach. J Intervent Cardiol 2000;87:116–118. 4. Cao QL, Du ZD, Joseph A, Koenig P, Heitschmidt M, Rhodes J, Hijazi ZM. Immediate and six-month results of the profile of the Amplatzer septal occluder as assessed by transesophageal echocariography. Am J Cardiol 2001;88:754–759. 5. Masura J, Gavora P, Formanek A, Hijazi ZM. Transcatheter closure of secundum atrial septal defects using the new self-centering Amplatzer septal occluder: initial human experience. Cathet Cardiovasc Diagn 1997;42:388–393. 6. Rhodes J, Hijazi ZM, Marx GR, Fulton DR. Aerobic exercise function of patients with persistent coronary artery aneurysms secondary to Kawasaki disease. Pediatr Cardiol 1996;17:226–230. 7. Beaver WL, Wasserman K, Whipp BJ. A new method for detecting anaerobic threshold by gas exchange. J Appl Physiol 1986;60:2020–2027. 8. Jones NL. Clinical Exercise Testing. Philadelphia, PA: WB Saunders, 1988: 174. 9. Clark AL, Poole-Wilson PA, Coats AJS. Effects of motivation on indices of exercise capacity in chronic heart failure. Br Heart J 1994;71:162–165. 10. Wasserman K, Hansen JE, Sue DY, Whipp BJ, Casaburin R. Prinicples of Exercise Testing and Interpretation. 2nd Edition. Philadelphia, PA: Lea & Febiger, 1994:66–133. 11. Cumming GR. Maximal exercise capacity of children with heart defects. Am J Cardiol 1978;42:613–620. 12. Goldberg SJ, Mendes F, Hurwitz R. Maximal exercise capability of children as a function of specific cardiac defects. Am J Cardiol 1969;23:349–353. 13. Schofield PM, Barber PV, Kingston T. Preoperative and postoperative pulmonary function tests in patients with atrial septal defect. Br Heart J 1985;54: 577–582. 14. Porter CJ, Feldt RH, Edwards WD, Seward JB, Schaff HV. Atrial septal defects. In: Emmanouilides GC, Riemenschneider TA, Allen HD, Gutgessell HP, eds. Heart Disease in Infants, Children and Adolescents. 5th Edition. Baltimore, MD: Williams and Wilkins, 1995:687–703. 15. Wasserman K. New concepts in assessing cardiovascular function. Circulation 1988;78:1060–1071.

9:40 Prospective evaluation of pulmonary function in adolescent idiopathic scoliosis relative to the surgical approach: minimum 5-year follow-up

Purpose of study: to evaluate pulmonary function changes 5 years or more prospectively after surgery in patients with adolescent idiopathic scoliosis (AIS) relative to the type of surgical approach used for the spinal arthrodesis (Table 1)Table 1Postoperative changes in PFTsGroupPreoperative FVC/FEV13-month PO1-year PO2-year PO5-year POG1 PSF-IC (n=43)2.80/2.392.86/2.432.94/2.463.13/2.703.26/2.76G2 PSF-TP (n=39)2.92/2.392.47/2.102.74/2.303.04/2.563.04/2.52G3 ASF-TC (n=15)3.09/2.692.44/2.392.71/2.472.96/2.562.83/2.42G4 ASF/PSF (n=12)2.38/2.002.11/1.652.33/1.962.44/2.092.54/2.15G2 + 3 + 4 (n=66)2.85/2.412.39/2.102.64/2.272.91/2.472.91/2.43PO = post-op..Methods used: A total of 109 patients with AIS undergoing surgical treatment were prospectively evaluated with pulmonary function tests (PFTs), forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) before surgery, 3 months, 1 year, 2 years and a minimum 5 years after surgery (5 to 14 years). All patients were divided into four groups. Group 1 (n=43) posterior spinal fusion with iliac crest bone graft (PSF-IC); Group 2 (n=39) PSF with thoracoplasty (PSF-TP); Group 3 (n=15) anterior fusion (ASF) with a rib resection thoracotomy (ASF-TC) and Group 4 (n=12) combined ASF and PSF with autogenous rib and iliac crest graft (ASF/PSF).of findings: Irrespective of the surgical approach used for the spinal arthrodesis, postoperative PFTs (absolute values) improved continuously until 2 years after surgery, then did not change between 2- and 5-year follow-up, except Group 1 (PSF-IC), which continued to improve up to 5 years after surgery. Five years after surgery, Group 1 had statistically increased PFTs both in absolute value and percent predicted, whereas patients in Groups 2, 3 and 4 had unchanged (Groups 2 and 4) or significantly decreased (Group 3) pulmonary function values (p<.05).Relationship between findings and existing knowledge: Irrespective of the surgical approach used, postoperative pulmonary function tests (absolute values) increase until 5 years after surgery. Patients who had no chest cage disruption (Group 1) had a significantly greater improvement in their pulmonary function values at 5 years after surgery than patients with chest cage disruption (Groups 2, 3 and 4).Overall significance of findings: We can choose more appropriate approaches for surgical candidates and predict the change of the pulmonary functions 5 years after operation.Disclosures: No disclosures.Conflict of interest: No conflicts.

Prediction of postoperative pulmonary function using perfusion magnetic resonance imaging of the lung

To assess semiquantitatively the regional distribution of lung perfusion using magnetic resonance (MR) perfusion imaging. Subjects were 20 consecutive patients with bronchogenic carcinoma, who underwent MR imaging (MRI) and radionuclide (RN) perfusion scans for preoperative evaluation. Three-dimensional (3D) images of whole lungs were obtained before and 7 seconds after bolus injection of contrast material (5 ml of Gd-DTPA). Subtraction images were constructed from these dynamic images. Lung areas enhanced with the contrast material were measured and multiplied by changes in signal intensity, summed for the whole lung, and the right-to-left lung ratios were calculated. The predicted postoperative forced expiratory volume in 1 second (FEV1) was estimated using MR and RN perfusion ratios. The correlation between perfusion ratios derived from the MR and RN studies was excellent (r = 0.92). Sixteen of 20 patients underwent surgery, and 12 patients had postoperative pulmonary function tests. The predicted FEV1 derived from the MR perfusion ratio correlated well with the postoperative FEV1 in the 12 patients (r = 0.68). Perfusion MRI is suitable for semiquantitative evaluation of regional pulmonary perfusion.

Effects of long intubation period on respiratory functions following open heart surgery.

The objective of the present study was to compare pre- and postoperative pulmonary function tests in adult patients who had intubation periods greater and less than 24 hours following elective open heart surgery. Group 1 consisted of 91 patients (18 females and 73 males) gr, whose intubation periods were more than 24 hours (mean: 8.1+/-18.6 hours); and group 2 75 patients (13 females and 62 males) who had intubation periods less than 24 hours (mean: 13.25+/-3.60 hours). The pulmonary function test measurements were obtained from a vitalograph before and after the operation (just before being discharged from the hospital), All patients underwent cardiopulmonary physiotherapy and a rehabilitation programme during their hospital stay. The patients were similar in height and weight. The duration of hospitalization of the patients who had a prolonged intubation period was 17.26+/-9.7 days, while that of the control group was 10.64+/-2.04 days (P<0.0001). When the preoperative pulmonary function test values of each patient were compared with the expected values, the percent values of forced expiratory volume for one second, flow velocity of the mid-forced expiration and forced expiratory flow which were achieved by group 2 were significantly high compared to those of group 1 (P=0.014, P= 0.03 and P<0.0001, respectively). However, the percent values of forced vital capacity were similar. When the percent variations of the differences between the pre- and postoperative pulmonary function test values of the groups were compared, all values except the flow velocity of the mid-forced expiration, and forced vital capacity, were found to be significantly lower statistically in the group having a prolonged intubation period. As a result, it was determined that the patients whose preoperative pulmonary function test values were poor, had longer intubation periods and similarly, they continued to be worse after the operation. We believe that it is advantageous to apply more intensive pulmonary rehabilitation for prolonged periods to these patients in the postoperative period.

Video-assisted lobectomy in elderly lung cancer patients.

We evaluated the pre-, intra- and postoperative outcome of video-assisted thoracic surgery lobectomy in elderly lung cancer patients to determine what factors may be disadvantageous. From June 1982 to May 2000, 707 patients underwent pulmonary resection for primary lung cancer. Of these, 87 patients with t1-2 peripheral lung cancer underwent lobectomy and postoperative pulmonary function tests and postoperative conditions at an average of 2.3 months postoperatively. Of these, 52 underwent video-assisted thoracic surgery lobectomy since 1994 and 35 lobectomy by standard thoracotomy. Video-assisted thoracic surgery lobectomy offered advantages in blood loss, chest wall damage, and minimal performance deterioration status. The percent vital capacity, percent forced expiratory in 1 second, and percent maximum ventilatory volume were well preserved in patients who underwent video-assisted thoracic surgery lobectomy. Multivariate logistic regression analysis identified operation duration as an independent risk factor in morbidity and operative procedure as an independent risk factor in performance deterioration. In stage IA and IB patients, 3-year-survival was 92.9% and 5-year survival 53.8% in those undergoing lobectomy by standard thoracotomy and 84.2% at 3 years and 60.1% at 5-years in those undergoing video-assisted thoracic surgery lobectomy. We thus consider video-assisted thoracic surgery lobectomy in this age group to be an effective procedure, but the long surgical duration is a risk factor in a poor clinical outcome.

Composite hyoid-sternohyoid interposition graft in the surgical treatment of laryngotracheal stenosis.

This article reports six patients with severe laryngotracheal stenosis. The causes of stenosis were tracheotomy (two cases); prolonged endotracheal intubation (one case); laryngeal trauma (two cases); and surgery with postoperative chemo- and radiotherapy, addressing a thyroid gland follicular adenocarcinoma (one case). Two patients were already tracheotomized. The main postoperative complication was necrosis of the graft in a female patient who had previously undergone treatment for thyroid follicular adenocarcinoma. All patients were decannulated 6 months postoperatively. Five patients were then regularly followed up, but we lost contact with one patient. Comparison between pre- and postoperative pulmonary function testing revealed an increased maximum inspiratory flow (Vi max50) in five cases between 0.57 l/s and 2.18 l/s. A helical scan with 3-dimensional reconstruction of the cervical area in four patients confirmed the presence and preservation of the hyoid bone graft. Four patients remained satisfied with their postoperative voice quality, one patient was dissatisfied, and one patient was not followed up. This technique is effective in adults with severe laryngotracheal stenosis, restricted to the first tracheal rings, providing one takes into consideration the main contraindications of the procedure: past history of radiotherapy and thyroid surgery.

Better pulmonary function and prognosis with video-assisted thoracic surgery than with thoracotomy

Background. Data regarding pulmonary function and prognosis after video-assisted thoracic surgery lobectomy are limited. Methods. From September 1992 to April 2000, 204 video-assisted thoracic surgery lobectomies were performed, and their preoperative and postoperative pulmonary function test results and prognoses were evaluated. Results. The postoperative to preoperative ratio of pulmonary function tests (vital capacity and forced expiratory volume in 1 s) were better in video-assisted thoracic surgery lobectomy than in open thoracotomy ( p < 0.0001). Furthermore, the 5-year survival rate of pathologic stage I lung cancers after video-assisted thoracic surgery was 97.0%, whereas that after open thoracotomy was 78.5% ( p = 0.0173; Mantel-Cox). Conclusions. Pulmonary function and prognosis were far better after video-assisted thoracic surgery lobectomy than after open thoracotomy.