OBJECTIVE
To develop an echocardiography method based on cardiac topography changes after previous pneumonectomy.
MATERIAL AND METHODS
The study included 37 patients aged 39—72 years after right-sided (n=15) and left-sided (n=22) pneumonectomy. Computed tomography was performed before surgery and in 12 months after intervention. Heart position was assessed using axial and frontal scans. Lateral, anteroposterior and angular displacements of the heart and its chambers were analyzed. Height changes were also assessed. Echocardiography was performed before surgery and in 12 months after intervention.
RESULTS
We have developed echocardiography method in patients after previous pneumonectomy. This approach is based on the patterns of cardiac displacement in long-term period after intervention. The optimal access points after left-sided pneumonectomy are localized at II—III intercostal space along the middle clavicular line and IV intercostal space along the middle axillary line on the left. After right-sided pneumonectomy, the optimal points are at III intercostal space along the middle clavicular line on the right and IV intercostal space along the right parasternal line. Heart is displaced towards surgery, posteriorly and upward after pneumonectomy. Left-sided pneumonectomy is followed by more significant displacements. Displacement is accompanied by heart rotation. Axial rotation is more significant after right-sided surgery (14.4±2.9° vs. 5.6±2.9°). Frontal rotation is also observed without significant differences for each side (on the right — 3.9±2.2°, on the left — 7.8±2.1°). Heart moves cranially within the height of one thoracic vertebra after pneumonectomy. Upward displacement is more significant after left-sided pneumonectomy.
CONCLUSION
Pneumonectomy results topographic and anatomical changes of heart position. This process is complex and multidirectional. After pneumonectomy, the heart moves towards surgical side, posteriorly, upward, and makes angular displacements in axial and frontal planes. These topographic and anatomical changes require correction of standard echocardiography access points. The proposed access points maximally take into account not only frontal displacement, but also its rotation and ensure reliable and optimal survey.
