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The Journal of Thoracic and Cardiovascular Surgery, Vol 93, 570-576, Copyright © 1987 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
CD Laros and CJ Westermann
The ventilatory function of 230 patients with pneumonectomy, performed at
ages ranging from 2 to 40 years, has been followed for more than 30 years
(mean 33 years). We have tried to analyze whether the available data gave
information about the nature and the mechanisms adapting the remaining lung
to the larger than normal pleural space and about the persistence of this
adaptation in the longer term. There were 32 patients with a persistent,
disturbed forced expiration (mean 50% of vital capacity). This group of
patients was excluded from the study to answer the above questions, because
the subdivisions of the total lung capacity in this group differed
significantly from those in the group of 98 patients with a normal forced
expiratory volume of 72% (mean) of vital capacity. The data of the 98
patients, who were subdivided into seven age groups at the time of
pneumonectomy, permitted the following conclusions: In the youngest age
group (0 to 5 years), the ventilatory capacity is hardly smaller than the
predicted capacity for two lungs; this suggests that compensatory growth by
way of hyperplasia might have been the most important adaptive mechanism in
this group. In the age group 6 to 20 years, a significant difference is
still found as compared to the group of patients operated on at an older
age; this difference indicates that in this period compensatory growth,
possibly mainly simple hypertrophy, still played an important but gradually
decreasing role. The fact that the effect of the adaptational mechanisms
could be observed more than 30 years after ablation of one lung, without
loss in quality of function (i.e., forced expiratory volume constituting a
normal percentage of the vital capacity), indicates that the adaptive
mechanisms also compensate for the loss in lung tissue in the longer term.
A striking finding was the stability of the tidal volume/functional
residual capacity ratio, which, especially in the younger age groups, was
very close to the predicted value for two lungs. This finding is in
agreement with the fact that most persons with a healthy remaining lung
lead a normal family and social life after pneumonectomy.
ARTICLES
Dilatation, compensatory growth, or both after pneumonectomy during childhood and adolescence. A thirty-year follow-up study
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