Am. J. Respir. Crit. Care Med., Volume 158, Number 4, October 1998, 1020-1025

Effect of Lung Volume Reduction Surgery on Gas Exchange and Pulmonary Hemodynamics at Rest and during Exercise

MONIQUE OSWALD-MAMMOSSER, ROMAIN KESSLER, GILBERT MASSARD, JEAN-MARIE WIHLM, EMMANUEL WEITZENBLUM, and JEAN LONSDORFER

Service des Explorations Fonctionnelles Respiratoires et de l'Exercice et J. E. CNRS 2105, et Service de Chirurgie Thoracique, Hôpitaux Universitaires de Strasbourg, Hôpital Civil; and Service de Pneumologie, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Strasbourg, France

Lung volume reduction surgery (LVRS) has become an extended surgery for emphysema in order to improve the dyspnea of severely affected patients. Because resection of lung areas may reduce the vascular bed, which is an important factor of pulmonary hypertension in emphysematous patients, especially during exercise, the aim of our study was to assess the outcome of pulmonary hemodynamics and gas exchange at rest and during exercise after LVRS. Nine patients had right heart catheterization before and 3 to 12 mo (mean, 4.5 mo) after LVRS. FEV₁ increased from 705 to 1,005 ml (p < 0.05) after LVRS. Pa_O2, Pa_CO2 and mean pulmonary artery pressure () did not change after LVRS, either at rest or during exercise. However, a significant overall decrease of the respiratory swings of the pulmonary artery diastolic pressure (Pd) at rest (median value, from 12 to 8 mm Hg, p < 0.01) and during exercise (from 20 to 15 mm Hg, p < 0.05) was observed. There was a significant correlation between the change in resting ( before minus after LVRS) and the change in resting Pd (r = 0.73, p < 0.03), and also between the change in exercising and the change in resting Pd (r = 0.80, p < 0.02). Significant correlations were also found between the change in exercising and the change in exercising Pa_O2 (r = 0.70, p < 0.05), and between the change in exercising and the change in exercising Pa_CO2 (r = 0.76, p < 0.03). We conclude that pulmonary hemodynamics in most cases are not impaired by LVRS either at rest or during exercise. The possible mechanisms influencing hemodynamics after a lung volume reduction procedure are discussed.

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