The application of application four-dimensional automatic right ventricular quantitative analysis in the evaluation of right heart function after pulmonary resection

LIU Hongjiao; LI Weihong; YANG Dongmei

Abstract：Objective To employ the advanced four-dimensional automated right ventricular quantification(4D Auto RV)technique as a tool for evaluating the early postoperative alterations in RV volume and function among patients who have undergone lung resection surgery.Methods A total of 51 patients who underwent thoracoscopic lung resection for pulmonary nodules in the First Affiliated Hospital of University of Science and Technology of China from January 2021 to December 2022 were selected,including 25 patients with simple segmental or wedge resection and 26 patients with lobectomy.Echocardiography was performed before and within 1 month after lung resection,and the change a in right ventricular volume and function after lung resection were assessed using the 4D Auto RV technique.Right ventricular volume parameters included end-diastolic volume(EDV),end-systolic volume(ESV),and stroke volume(SV).Right ventricular function parameters included right ventricular ejection fraction(RVEF),tricuspid annular plane systolic excursion(TAPSE),fractional area change(FAC),and right ventricular longitudinal strain values[global longitudinal strain(RV-GPLS),free wall longitudinal strain(RV-FWPLS)].Results Following early stages post-thoracoscopic lung resection,there was a significant increase in right ventricular volume,manifesting as statistically significant changes in both EDV and ESV before and after surgery(P＜0.05).However,the change in stroke volume pre-and post-surgery did not reach statistical significance(P＞0.05).Upon further analysis of right ventricular functional parameters,there were significant statistical changes in FAC,RV-GPLS,and RV-FWPLS before and after surgery(P＜0.05),indicating that these parameters were more sensitive to the alterations in right ventricular function induced by the surgery.The changes in RVEF and TAPSE did not achieve statistical significance pre-and post-surgery(P＞0.05).The differences in post-operative right ventricular volume and functional parameter changes between patients undergoing either limited resection such as segmentectomy/wedge resection versus lobectomy were not statistically significant(P＞0.05).Conclusion In the phase following lung resection,despite the possible absence of overt clinical symptoms,the utilization of 4D Auto RV technology has revealed a phenomenon of right ventricular dilation,indicative of early onset of mild right ventricular dysfunction.This dysfunction manifests as decrements in FAC,RV-GPLS and RV-FWPLS.