Farbod N Rahaghi1, Daniel Lazea2, Saba Dihya2, Raúl San José Estépar3, Raphael Bueno4, David Sugarbaker4, Gyorgy Frendl2, George R Washko5. 1. Pulmonary and Critical Care Division of Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, PBB CA-3, Boston, Massachusetts 02115. Electronic address: frahaghi@partners.org. 2. Department of Anesthesiology, Perioperative and Pain Medicine and Critical Care Medicine, Brigham and Women's Hospital, 75 Francis Street, CWN-L1, Boston, Massachusetts 02115. 3. Department of Radiology, Harvard School of Medicine, Surgical Planning Laboratory, 1249 Boylston Street, 2nd Floor, Room 216, Boston, Massachusetts 02215. 4. Division of Thoracic Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts 02115. 5. Pulmonary and Critical Care Division of Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, PBB CA-3, Boston, Massachusetts 02115.
Abstract
RATIONALE AND OBJECTIVES: Pulmonary edema and pulmonary hypertension are postsurgical complications of pneumonectomy that may represent the remaining pulmonary vasculature's inability to accommodate the entirety of the cardiac output. Quantification of the aggregate pulmonary vascular cross-sectional area (CSA) has been used to study the development of pulmonary vascular disease in smokers. In this study, we applied this technique to demonstrate the potential utility of pulmonary vascular quantification in surgical risk assessment. Our hypothesis was that those subjects with the lowest aggregate vascular CSA in the nonoperative lung would be most likely to have elevated pulmonary vascular pressures in the postoperative period. MATERIALS AND METHODS: A total of 61 subjects with postoperative hemodynamics and adequate imaging were identified from 159 patients undergoing pneumonectomies for mesothelioma. The total CSA of blood vessels perpendicular to the plane of computed tomographic (CT) scan slices was computed for blood vessels <5 mm(2) (CSA 5 mm). This measurement expressed as a percentage of lung parenchyma area (CSA 5%) was compared to postoperative hemodynamic measurements obtained by right heart catheterization. RESULTS: In patients where a contrasted CT scan was used (n = 26), CSA 5% was correlated with postoperative day 0 minimum cardiac index (R = 0.37, P = .03) but not with the maximum pulmonary arterial pressures. In patients with noncontrast CT scans (n = 35), CSA 5% was inversely correlated with postoperative day 0 maximum pulmonary arterial pressures (R = 0.43, P = .03) but not with the minimum cardiac index. The preoperative perfusion fraction of the nonsurgical lung did not correlate with postoperative hemodynamics. CONCLUSIONS: CSA of pulmonary vasculature with an area ≤5 mm(2) has potential in estimating the ability of pulmonary vascular bed to accommodate postsurgical changes in pneumonectomy.
RATIONALE AND OBJECTIVES:Pulmonary edema and pulmonary hypertension are postsurgical complications of pneumonectomy that may represent the remaining pulmonary vasculature's inability to accommodate the entirety of the cardiac output. Quantification of the aggregate pulmonary vascular cross-sectional area (CSA) has been used to study the development of pulmonary vascular disease in smokers. In this study, we applied this technique to demonstrate the potential utility of pulmonary vascular quantification in surgical risk assessment. Our hypothesis was that those subjects with the lowest aggregate vascular CSA in the nonoperative lung would be most likely to have elevated pulmonary vascular pressures in the postoperative period. MATERIALS AND METHODS: A total of 61 subjects with postoperative hemodynamics and adequate imaging were identified from 159 patients undergoing pneumonectomies for mesothelioma. The total CSA of blood vessels perpendicular to the plane of computed tomographic (CT) scan slices was computed for blood vessels <5 mm(2) (CSA 5 mm). This measurement expressed as a percentage of lung parenchyma area (CSA 5%) was compared to postoperative hemodynamic measurements obtained by right heart catheterization. RESULTS: In patients where a contrasted CT scan was used (n = 26), CSA 5% was correlated with postoperative day 0 minimum cardiac index (R = 0.37, P = .03) but not with the maximum pulmonary arterial pressures. In patients with noncontrast CT scans (n = 35), CSA 5% was inversely correlated with postoperative day 0 maximum pulmonary arterial pressures (R = 0.43, P = .03) but not with the minimum cardiac index. The preoperative perfusion fraction of the nonsurgical lung did not correlate with postoperative hemodynamics. CONCLUSIONS:CSA of pulmonary vasculature with an area ≤5 mm(2) has potential in estimating the ability of pulmonary vascular bed to accommodate postsurgical changes in pneumonectomy.
Authors: Raúl San José Estépar; Gregory L Kinney; Jennifer L Black-Shinn; Russell P Bowler; Gordon L Kindlmann; James C Ross; Ron Kikinis; Meilan K Han; Carolyn E Come; Alejandro A Diaz; Michael H Cho; Craig P Hersh; Joyce D Schroeder; John J Reilly; David A Lynch; James D Crapo; J Michael Wells; Mark T Dransfield; John E Hokanson; George R Washko Journal: Am J Respir Crit Care Med Date: 2013-07-15 Impact factor: 21.405
Authors: Shin Matsuoka; George R Washko; Tsuneo Yamashiro; Raul San Jose Estepar; Alejandro Diaz; Edwin K Silverman; Eric Hoffman; Henry E Fessler; Gerard J Criner; Nathaniel Marchetti; Steven M Scharf; Fernando J Martinez; John J Reilly; Hiroto Hatabu Journal: Am J Respir Crit Care Med Date: 2009-10-29 Impact factor: 21.405
Authors: Shin Matsuoka; George R Washko; Mark T Dransfield; Tsuneo Yamashiro; Raul San Jose Estepar; Alejandro Diaz; Edwin K Silverman; Samuel Patz; Hiroto Hatabu Journal: Acad Radiol Date: 2009-09-30 Impact factor: 3.173