Document Detail


Clinical assessment of unilateral pulmonary artery occlusion test with dobutamine infusion. Expansion of surgical indications in patients with primary lung cancer and impaired cardiopulmonary functions.
MedLine Citation:
PMID:  11197825     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: We evaluated the possibility of expanding indications for pulmonary resection based on an assessment of the pressure-flow relationship in pulmonary circulation. METHODS: In 6 of 28 lung cancer patients whose total pulmonary vascular resistance index exceeded the threshold during unilateral pulmonary artery occlusion testing, we conducted unilateral pulmonary artery occlusion testing with dobutamine administration, followed by lung resection. We studied hemodynamics during testing and derived a new indication for pulmonary resection from the postoperative course. RESULTS: Cardiac output was 3.82 +/- 0.74 l/min before testing, 3.66 +/- 0.76 l/min during pulmonary artery occlusion testing, and 5.92 +/- 1.78 l/min during unilateral pulmonary artery occlusion testing with dobutamine infusion. The total pulmonary vascular resistance index was 890 +/- 350 dyne.sec.cm-5.m2 before testing, 1170 +/- 320 dyne.sec.cm-5.m2 during testing, and 800 +/- 160 dyne.sec.cm-5.m2 during testing with dobutamine infusion. Cardiac output increased (p = 0.014) during unilateral pulmonary artery occlusion testing with dobutamine infusion, and the total pulmonary vascular resistance index significantly decreased (p = 0.034). Of the 4 patients eligible for lobectomy, 2 underwent the procedure--one undergoing segmentectomy in which pulmonary metastasis was found during surgery and the other undergoing radiotherapy for cN2 disease with chest wall invasion. Of the 2 initially ineligible for lobectomy, one underwent partial pulmonary resection and the other underwent lobectomy because the total pulmonary vascular resistance index was less than 800 dyne.sec.cm-5.m2 during selective pulmonary artery occlusion testing with dobutamine infusion, indicating eligibility for lobectomy. No severe complications of cardiopulmonary function failure after surgery occurred in any of the 5 cases. CONCLUSIONS: Unilateral pulmonary artery occlusion testing with dobutamine infusion is useful in determining patient eligibility for pulmonary resection.
Authors:
T Ikeda; T Onuki; M Nishiuchi; M Kanzaki; S Nitta
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Japanese journal of thoracic and cardiovascular surgery : official publication of the Japanese Association for Thoracic Surgery = Nihon Kyōbu Geka Gakkai zasshi     Volume:  48     ISSN:  1344-4964     ISO Abbreviation:  Jpn. J. Thorac. Cardiovasc. Surg.     Publication Date:  2000 Dec 
Date Detail:
Created Date:  2001-02-01     Completed Date:  2001-03-15     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  100884261     Medline TA:  Jpn J Thorac Cardiovasc Surg     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  802-8     Citation Subset:  IM    
Affiliation:
Department of Surgery I, Tokyo Women's Medical University, School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
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MeSH Terms
Descriptor/Qualifier:
Aged
Blood Pressure
Cardiac Output
Dobutamine / diagnostic use*
Heart Rate
Hemodynamics*
Humans
Infusions, Intra-Arterial
Lung Neoplasms / physiopathology,  surgery*
Middle Aged
Plethysmography*
Pneumonectomy / methods*
Pulmonary Artery / physiology
Pulmonary Circulation*
Vascular Resistance
Chemical
Reg. No./Substance:
34368-04-2/Dobutamine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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