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J Thorac Cardiovasc Surg 2007;134:1300-1305
© 2007 The American Association for Thoracic Surgery

General Thoracic Surgery

Reinitiation of compensatory lung growth after subsequent lung resection

Lucas G. Fernandez, MD, DSc, Christopher K. Mehta, Irving L. Kron, MD, Victor E. Laubach, PhD*

Department of Surgery, University of Virginia, Charlottesville, Va.

Received for publication March 9, 2007; revisions received July 6, 2007; accepted for publication July 10, 2007.

* Address for reprints: Victor E. Laubach, PhD, University of Virginia Health System, Department of Surgery, PO Box 801359, Charlottesville, VA 22908. (Email: laubach{at}virginia.edu).

Objective: In experimental animals, pneumonectomy results in rapid, hyperplastic compensatory growth of the remaining lung. The limits of this induced growth are unknown. We tested the hypothesis that compensatory growth can be reinitiated in the same lung after subsequent lung resection.

Methods: A left thoracotomy (Sham group) or left pneumonectomy (PNX group) was performed in Sprague–Dawley rats. A third group underwent left pneumonectomy followed 4 weeks later by a bilobectomy of the right upper and middle lobes (PNX+LBX group). Four weeks after bilobectomy in the PNX+LBX group (8 weeks in the Sham and PNX groups), right ventricular pressures were measured by using the open chest technique, and total lung weight and lower plus cardiac lobe weight indices were measured. Lungs were inflation fixed at 25 cm H2O to measure lobe volume index and to perform morphometric measurements on lung sections. Right ventricle/left ventricle plus septum weight index was measured as another index of pulmonary hypertension.

Results: Total lung weight index was similar in all groups. Pneumonectomy resulted in increased lower plus cardiac lobe weight and volume indices, which were significantly augmented in the PNX+LBX group. The PNX+LBX group underwent a significant increase in total volume of respiratory region, airspace, and tissue and a decrease in alveolar surface density versus the PNX group. The PNX+LBX group also had significantly increased right ventricular systolic pressure and right ventricle/left ventricle plus septum index.

Conclusion: These results demonstrate that compensatory growth can be reinitiated in lungs that had previously undergone postpneumonectomy compensatory growth. This subsequent growth, however, is more hypertrophic, and pulmonary hypertension develops despite subsequent compensatory growth.

Abbreviations and Acronyms CLG = compensatory lung growth; LBX = lobectomy; PNX = pneumonectomy; RVSP = right ventricular systolic pressure; Sv = alveolar surface density; TVra = total volume of the respiratory airspace; TVrt = total volume of respiratory tissue; TVvr = total volume of the respiratory region






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