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      Combined Mitral Valve Replacement and Ravitch Procedures in a Patient with Previous Pneumonectomy: Case Report and Review of the Literature

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          Abstract

          Abstract Introduction: Significant anatomical and functional changes occur following pneumonectomy. Mediastinal structures displace toward the side of the resected lung, pulmonary reserve is reduced. Owing to these changes, surgical access to heart and great vessels becomes challenging, and there is increased risk of postoperative pulmonary complications. Methods: We performed a mitral valve replacement combined with a Ravitch procedure in a young female with previous left pneumonectomy and pectus excavatum. Results: She was discharged on postoperative day 9 and remains symptom-free 3 months after surgery. Conclusion: Thorough preoperative evaluation and intensive respiratory physiotherapy are essential before performing cardiac operations on patients with previous pneumonectomy.

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          Most cited references39

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          Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery: a randomized clinical trial.

          Erik Hulzebos, Paul J M Helders, Nine Favié … (2006)
          Postoperative pulmonary complications (PPCs) after coronary artery bypass graft (CABG) surgery are a major source of morbidity and mortality, and increase length of hospital stay and resource utilization. The prehospitalization period before CABG surgery may be used to improve a patient's pulmonary condition. The efficacy of preoperative inspiratory muscle training (IMT) in reducing the incidence of PPCs in high-risk patients undergoing CABG surgery has not yet been determined. To evaluate the prophylactic efficacy of preoperative IMT on the incidence of PPCs in high-risk patients scheduled for elective CABG surgery. A single-blind, randomized clinical trial conducted at the University Medical Center Utrecht, Utrecht, the Netherlands, with enrollment between July 2002 and August 2005. Of 655 patients referred for elective CABG surgery, 299 (45.6%) met criteria for high risk of developing PPCs, of whom 279 were enrolled and followed up until discharge from hospital. Patients were randomly assigned to receive either preoperative IMT (n = 140) or usual care (n = 139). Both groups received the same postoperative physical therapy. Incidence of PPCs, especially pneumonia, and duration of postoperative hospitalization. Both groups were comparable at baseline. After CABG surgery, PPCs were present in 25 (18.0%) of 139 patients in the IMT group and 48 (35.0%) of 137 patients in the usual care group (odds ratio [OR], 0.52; 95% confidence interval [CI], 0.30-0.92). Pneumonia occurred in 9 (6.5%) of 139 patients in the IMT group and in 22 (16.1%) of 137 patients in the usual care group (OR, 0.40; 95% CI, 0.19-0.84). Median duration of postoperative hospitalization was 7 days (range, 5-41 days) in the IMT group vs 8 days (range, 6-70 days) in the usual care group by Mann-Whitney U statistic (z = -2.42; P = .02). Preoperative IMT reduced the incidence of PPCs and duration of postoperative hospitalization in patients at high risk of developing a pulmonary complication undergoing CABG surgery. isrctn.org Identifier: ISRCTN17691887.
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            Pulmonary function and exercise capacity after lung resection.

            A Perruchoud, C Wyser, M Tamm … (1996)
            The influence of pulmonary resection on functional capacity can be assessed in different ways. The aim of this study was to compare the effect of lobectomy and pneumonectomy on pulmonary function tests (PFT), exercise capacity and perception of symptoms. Sixty eight patients underwent functional assessment with PFT and exercise testing before (Preop), and 3 and 6 months after lung resection. In 50 (36 males and 14 females; mean age 61 yrs) a lobectomy was performed and in 18 (13 males and 5 females; mean age 59 yrs) a pneumonectomy was performed. Three months after lobectomy, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), total lung capacity (TLC), transfer factor of the lungs for carbon monoxide (TL,CO) and maximal oxygen uptake (V'O2,max) were significantly lower than Preop values, increasing significantly from 3 to 6 months after resection. Three months after pneumonectomy, all parameters were significantly lower than Preop values and significantly lower than postlobectomy values and did not recover from 3 to 6 months after resection. At 6 months after resection significant deficits persisted in comparison with Preop: for FVC 7% and 36%, FEV1 9% and 34%, TLC 10% and 33% for lobectomy and pneumonectomy, respectively; and V'O2,max 20% after pneumonectomy only. Exercise was limited by leg muscle fatigue in 53% of all patients at Preop. This was not altered by lobectomy, but there was a switch to dyspnoea as the limiting factor after pneumonectomy (61% of patients at 3 months and 50% at 6 months after resection). Furthermore, pneumonectomy compared to lobectomy led to a significantly smaller breathing reserve (mean +/- SD) (28 +/- 13 vs 37 +/- 16% at 3 months; and 24 +/- 11% vs 33 +/- 12% at 6 months post resection) and lower arterial oxygen tension at peak exercise 10.1 +/- 1.5 vs 11.5 +/- 1.6 kPa (76 +/- 11 vs 86 +/- 12 mmHg) at 3 months; 10.1 +/- 1.3 vs 11.3 +/- 1.6 kPa (76 +/- 10 vs 85 +/- 12 mmHg) at 6 months postresection. We conclude that measurements of conventional pulmonary function tests alone overestimate the decrease in functional capacity after lung resection. Exercise capacity after lobectomy is unchanged, whereas pneumonectomy leads to a 20% decrease, probably due to the reduced area of gas exchange.
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              The postpneumonectomy state.

              Scott E Kopec, Richard Irwin, Cynthia Umali-Torres … (1998)
              Article 0 comments Cited 26 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Ilyas Kayacioglu: Role: ND
                Ahmet Can Topcu: Role: ND
                Kamile Ozeren: Role: ND
                Yasin Ozden: Role: ND
                Ahmet Bolukcu: Role: ND
                Mehmet Yildirim: Role: ND
                Journal
                Journal ID (publisher-id): rbccv
                Title: Brazilian Journal of Cardiovascular Surgery
                Abbreviated Title: Braz. J. Cardiovasc. Surg.
                Publisher: Sociedade Brasileira de Cirurgia Cardiovascular (São José do Rio Preto, SP, Brazil )
                ISSN (Print): 0102-7638
                ISSN (Electronic): 1678-9741
                Publication date (Print and electronic): December 2018
                Volume: 33
                Issue: 6
                Pages: 608-617
                Affiliations
                [1] Istanbul orgnameDr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital orgdiv1Department of Cardiovascular Surgery Turkey
                [2] Istanbul orgnameDr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital orgdiv1Department of Thoracic Surgery Turkey
                Article
                Publisher ID: S0102-76382018000600608
                DOI: 10.21470/1678-9741-2018-0055
                SO-VID: 22aea043-97f9-4ba1-bed5-ded6fd57add6
                License:

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                Date received : 23 February 2018
                Date accepted : 20 June 2018
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 39, Pages: 10
                Product

                SciELO Brazil

                Categories
                Subject: Review Article

                Keywords: Chest Wall/surgery,Heart Valve Prosthesis Implantation,Mitral Valve/surgery,Funnel Chest,Pneumonectomy
                Data availability:
                Keywords: Chest Wall/surgery, Heart Valve Prosthesis Implantation, Mitral Valve/surgery, Funnel Chest, Pneumonectomy

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