J Vet Sci.  2010 Sep;11(3):257-264. 10.4142/jvs.2010.11.3.257.

Pre- and post-operative cardiac evaluation of dogs undergoing lobectomy and pneumonectomy

• Kocaturk M
• Salci H
• Yilmaz Z
• Bayram AS
• Koch J

• KMID: 1093501
• DOI: http://doi.org/10.4142/jvs.2010.11.3.257

Abstract

This study aimed to assess the influence of lobectomy and pneumonectomy on cardiac rhythm and on the dimensions and function of the right-side of the heart. Twelve dogs undergoing lobectomy and eight dogs undergoing pneumonectomy were evaluated preoperatively and one month postoperatively with electrocardiography and Doppler echocardiography at rest. Pulmonary artery systolic pressure (PASP) was estimated by the tricuspid regurgitation jet (TRJ) via the pulse wave Doppler velocity method. Systemic inflammatory response syndrome criteria (SIRS) were also evaluated based on the clinical and hematological findings in response to lobectomy and pneumonectomy. Following lobectomy and pneumonectomy, we predominantly detected atrial fibrillation and varying degrees of atrioventricular block (AVB). Dogs that died within seven days of the lobectomy (n = 2) or pneumonectomy (n = 1) had complete AVB. Preoperative right atrial, right ventricular, and pulmonary artery dimensions increased gradually during the 30 days (p<0.05) following pneumonectomy, but did not undergo significant changes during that same period after lobectomy. Mean PASP was 56.0 +/- 4.5 mmHg in dogs having significant TRJ after pneumonectomy. Pneumonectomy, but not lobectomy, could lead to increases (p<0.01) in the SIRS score within the first day post-surgery. In brief, it is important to conduct pre- and postoperative cardiac evaluation of dogs undergoing lung resections because cardiac problems are a common postoperative complication after such surgeries. In particular, complete AVB should be considered a life-threatening complication after pneumonectomy and lobectomy. In addition, pneumonectomy appears to increase the likelihood of pulmonary hypertension development in dogs.

Keyword

dog; heart function; lobectomy; pneumonectomy; pulmonary hypertension

MeSH Terms

Animals
Atrial Fibrillation/diagnosis/veterinary
Atrioventricular Block/diagnosis/*veterinary
Blood Pressure/physiology
Dogs
Echocardiography/veterinary
Electrocardiography/veterinary
Pneumonectomy/adverse effects/*veterinary
Postoperative Care/methods/*veterinary
Postoperative Complications/diagnosis/*veterinary
Preoperative Care/methods/*veterinary
Systemic Inflammatory Response Syndrome/diagnosis/etiology/veterinary
Tricuspid Valve Insufficiency/diagnosis/etiology/veterinary

Figure

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  Fig. 1 Systemic inflammatory response syndrome (SIRS) criteria, one day (-1) before and 30 days after lobectomy and pneumonectomy. *p<0.05; **p<0.001; compared to preoperative value. †p<0.05; ††p<0.01; differences between the groups on the same day.

• 

  Fig. 2 Echocardiographic results. (A) Right atrial, (B) right ventricular, and (C) pulmonary artery dimensions, (D) tricuspid valve E/A ratio, and (E) left atrium to aorta ratio one day (-1) before and 30 days after lobectomy and pneumonectomy. *p<0.05 and †p<0.01; compared to preoperative value.

Reference

1. Amar D, Burt ME, Roistacher N, Reinsel RA, Ginsberg RJ, Wilson RS. Value of perioperative Doppler echocardiography in patients undergoing major lung resection. Ann Thorac Surg. 1996. 61:516–520.

2. Amar D, Roistacher N, Burt M, Reinsel RA, Ginsberg RJ, Wilson RS. Clinical and echocardiographic correlates of symptomatic tachydysrhythmias after noncardiac thoracic surgery. Chest. 1995. 108:349–354.

3. Amar D, Roistacher N, Burt ME, Rusch VW, Bains MS, Leung DH, Downey RJ, Ginsberg RJ. Effects of diltiazem versus digoxin on dysrhythmias and cardiac function after pneumonectomy. Ann Thorac Surg. 1997. 63:1374–1381.

4. Bach DS, Curtis JL, Christensen PJ, Iannettoni MD, Whyte RI, Kazerooni EA, Armstrong W, Martinez FJ. Preoperative echocardiographic evaluation of patients referred for lung volume reduction surgery. Chest. 1998. 114:972–980.

5. Bellenger CR, Hunt GB, Goldsmid SE, Pearson MR. Outcomes of thoracic surgery in dogs and cats. Aust Vet J. 1996. 74:25–30.

6. Cagirici U, Nalbantgil S, Cakan A, Turhan K. A new algorithm for preoperative cardiac assessment in patients undergoing pulmonary resection. Tex Heart Inst J. 2005. 32:159–162.

7. Curtis JJ, Parker BM, McKenney CA, Wagner-Mann CC, Walls JT, Demmy TL, Schmaltz RA. Incidence and predictors of supraventricular dysrhythmias after pulmonary resection. Ann Thorac Surg. 1998. 66:1766–1771.

8. Dyszkiewicz W, Skrzypczak M. Atrial fibrillation after surgery of the lung: clinical analysis of risk factors. Eur J Cardiothorac Surg. 1998. 13:625–628.

9. Fahmy Elnoamany M, Abdelraouf Dawood A. Right ventricular myocardial isovolumic relaxation time as novel method for evaluation of pulmonary hypertension: correlation with endothelin-1 levels. J Am Soc Echocardiogr. 2007. 20:462–469.

10. Foroulis CN, Kotoulas CS, Kakouros S, Evangelatos G, Chassapis C, Konstantinou M, Lioulias AG. Study on the late effect of pneumonectomy on right heart pressures using Doppler echocardiography. Eur J Cardiothorac Surg. 2004. 26:508–514.

11. Fossum TW. Small Animal Surgery. 2002. St. Louis: Mosby;760–770.

12. Hawkins EC. Ettinger SJ, Feldman EC, editors. Pulmonary parenchymal diseases. Textbook of Veterinary Internal Medicine: Diseases of the Dog and Cat. 2000. 5th ed. Philadelphia: Saunders;1061–1088.

13. Huez S, Vachiéry JL, Unger P, Brimioulle S, Naeije R. Tissue Doppler imaging evaluation of cardiac adaptation to severe pulmonary hypertension. Am J Cardiol. 2007. 100:1473–1478.

14. Irino ET, Stopiglia AJ, Larsson MHMA, Guerra JL, Simoes EA, Shinkai MT, Fantoni DT, Otsuki DA, Freitas RR, Saldiva PHN, Jatene FB. Comparative study between manual and mechanical suture of bronchial stamp in dogs submited to left pneumonectomy: histopathological evaluation of right lung and electrocardiographical evaluation. Braz J Vet Res Anim Sci. 2004. 41:58–66.

15. Johnson L, Boon J, Orton EC. Clinical characteristics of 53 dogs with Doppler-derived evidence of pulmonary hypertension: 1992-1996. J Vet Intern Med. 1999. 13:440–447.

16. Kittleson MD, Kienle RD. Small Animal Cardiovascular Medicine. 1998. St. Louis: Mosby;433–449.

17. Laaban JP, Diebold B, Zelinski R, Lafay M, Raffoul H, Rochemaure J. Noninvasive estimation of systolic pulmonary artery pressure using Doppler echocardiography in patients with chronic obstructive pulmonary disease. Chest. 1989. 96:1258–1262.

18. Lansdowne JL, Monnet E, Twedt DC, Dernell WS. Thoracoscopic lung lobectomy for treatment of lung tumors in dogs. Vet Surg. 2005. 34:530–535.

19. Liptak JM, Monnet E, Dernell WS, Rizzo SA, Withrow SJ. Pneumonectomy: four case studies and a comparative review. J Small Anim Pract. 2004. 45:441–447.

20. Miller MS, Tilley LP, Smith FWK, Fox PR. Fox PR, Sisson D, Moïse NS, editors. Electrocardiography. Textbook of Canine and Feline Cardiology: Principles and Clinical Practice. 1999. Philadelphia: Saunders;67–105.

21. Moise NS, Fox PR. Fox PR, Sisson D, Moïse NS, editors. Echocardiography. Textbook of Canine and Feline Cardiology: Principles and Clinical Practice. 1999. Philadelphia: Saunders;130–171.

22. Murphy ST, Ellison GW, Mckiernan BC, Mathews KG, Kubilis PS. Pulmonary lobectomy in the management of pneumonia in dogs: 59 cases (1972-1994). J Am Vet Med Assoc. 1997. 210:235–239.

23. Neath PJ, Brockman DJ, King LG. Lung lobe torsion in dogs: 22 cases (1981-1999). J Am Vet Med Assoc. 2000. 217:1041–1044.

24. Nelson AW, Monnet E. Slatter DH, editor. Lungs. Textbook of Small Animal Surgery. 2003. 3rd ed. Philadelphia: Saunders;880–889.

25. Okada M, Ota T, Okada M, Matsuda H, Okada K, Ishii N. Right ventricular dysfunction after major pulmonary resection. J Thorac Cardiovasc Surg. 1994. 108:503–511.

26. Reed CE, Dorman BH, Spinale FG. Mechanisms of right ventricular dysfunction after pulmonary resection. Ann Thorac Surg. 1996. 62:225–232.

27. Reed CE, Spinale FG, Crawford FA Jr. Effect of pulmonary resection on right ventricular function. Ann Thorac Surg. 1992. 53:578–582.

28. Rena O, Papalia E, Oliaro A, Casadio C, Ruffini E, Filosso PL, Sacerdote C, Maggi G. Supraventricular arrhythmias after resection surgery of the lung. Eur J Cardiothorac Surg. 2001. 20:688–693.

29. Rubin LJ. Approach to the diagnosis and treatment of pulmonary hypertension. Chest. 1989. 96:659–664.

30. Salci H, Kennerman E, Celimli N, Torun S. Use of a Heimlich flutter valve in a dog with spontaneous pneumothorax. Aust Vet Pract. 2005. 35:47–51.

31. Sasaki Y, Kitagawa H, Hirano Y. Relationship between pulmonary arterial pressure and lesions in the pulmonary arteries and parenchyma, and cardiac valves in canine dirofilariasis. J Vet Med Sci. 1992. 54:739–744.

32. Schober KE, Baade H. Doppler echocardiographic prediction of pulmonary hypertension in West Highland white terriers with chronic pulmonary disease. J Vet Intern Med. 2006. 20:912–920.

33. Serres FJ, Chetboul V, Tissier R, Carlos Sampedrano C, Gouni V, Nicolle AP, Pouchelon JL. Doppler echocardiography-derived evidence of pulmonary arterial hypertension in dogs with degenerative mitral valve disease: 86 cases (2001-2005). J Am Vet Med Assoc. 2006. 229:1772–1778.

34. Shields TW, Locicero J, Ponn RB, Rusch VW. General Thoracic Surgery. 2004. Philadelphia: Lippincott Williams & Wilkins;564–592.

35. Tramarin R, Torbicki A, Marchandise B, Laaban JP, Morpurgo M. Doppler echocardiographic evaluation of pulmonary artery pressure in chronic obstructive pulmonary disease. A European multicentre study. Eur Heart J. 1991. 12:103–111.

36. Uehara Y. An attempt to estimate the pulmonary artery pressure in dogs by means of pulsed Doppler echocardiography. J Vet Med Sci. 1993. 55:307–312.

37. Yano T, Yokoyama H, Fukuyama Y, Takai E, Mizutani K, Ichinose Y. The current status of postoperative complications and risk factors after a pulmonary resection for primary lung cancer. A multivariate analysis. Eur J Cardiothorac Surg. 1997. 11:445–449.

38. Yilmaz Z, Senturk S. Characterisation of lipid profiles in dogs with parvoviral enteritis. J Small Anim Pract. 2007. 48:643–650.

39. Yu CM, Sanderson JE, Chan S, Yeung L, Hung YT, Woo KS. Right ventricular diastolic dysfunction in heart failure. Circulation. 1996. 93:1509–1514.