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PubMed1983

Anterior transmural myocardial infarction: effects of surgical coronary reperfusion on global and regional left ventricular function.

Global and regional left ventricular function were assessed before and after surgical coronary reperfusion in 54 patients surviving anterior transmural myocardial infarction. Two groups were identified. Group I (n = 34) was treated within 4.8 +/- 0.7 (mean +/- standard deviation) hours of onset of symptoms of anterior transmural myocardial infarction, and Group II (n = 20) was treated 9.2 +/- 4.8 hours from the onset of symptoms (p less than 0.01). On study entry, the two groups were similar in all characteristics except global left ventricular ejection fraction (48 +/- 9 versus 42 +/- 13%, p less than 0.05). Regional ejection fraction was obtained by computer-assisted planimetry from ventriculographic tracings at end-systole and end-diastole. The anterior wall was divided into four equal segments from the apex (area 1) to base (area 4). Areas 2 and 3 defined the midportion of the anterior wall of the left ventricle. This yielded four fractional changes expressed as ejection fraction in percent. Global and regional ejection fractions (from apex to base) of the anterior wall significantly improved in Group I (from 48 +/- 9 to 55 +/- 11%; 7 +/- 17 to 18 +/- 20%; 12 +/- 14 to 25 +/- 18%; 25 +/- 15 to 38 +/- 17%; and 39 +/- 13 to 41 +/- 12%) (p less than 0.05, except for the basal area), but only to a minor degree in Group II (from 42 +/- 13 to 45 +/- 16%; 9 +/- 10 to 13 +/- 15%; 10 +/- 10 to 17 +/- 10%; 27 +/- 16 to 32 +/- 14%; and 37 +/- 10 to 36 +/- 13%) (all p values were not significant [NS] except for region 2). These data suggest significant enhancement of global function and regional wall motion in selected patients if surgical reperfusion is performed within 6 hours from the onset of symptoms of anterior infarction. Little improvement can be expected when the procedure is instituted later than 6 hours from peak symptoms, although improvement in some patients occurs if adequate collateral perfusion or nontotal left anterior descending coronary occlusion is present. In spite of functional improvements, some contractile deficit persisted throughout the period studied even when successful reperfusion was achieved early during evolving anterior transmural myocardial infarction.

Adult↗
PubMed2002

Estimation of global left ventricular function from the velocity of longitudinal shortening.

AIMS: To determine if global ventricular function can be assessed from the long-axis contraction of the left ventricle, we compared pulsed-wave Doppler myocardial imaging of mitral annular motion to radionuclide ventriculography. METHODS AND RESULTS: We studied 51 patients (56 +/- 10 years, 11 women) with a radionuclide ejection fraction of 52 +/- 13% (15%-70%). Peak systolic velocities of medial and lateral mitral annular motion correlated with ejection fraction (0.55 and 0.54, respectively; P < 0.001), as did the time-velocity integrals (0.57 and 0.58, respectively; P < 0.001). Correlations were higher in normal ventricles (0.62-0.69) than in patients with previous myocardial infarction (0.39-0.64). Patients with anterior myocardial infarction had the lowest correlations (0.39-0.46). The best differentiation of normal (> or = 50%) from abnormal (< 50%) ejection fraction was provided by peak systolic velocity > or = 8 cm/sec for the medial (sensitivity 80%, specificity 89%) or lateral (sensitivity 80%, specificity 92%) mitral annulus. CONCLUSION: Global left ventricular function can be estimated by recording mitral annular velocity. The implementation of a cutoff limit of 8 cm/sec gave a simple guide for differentiating between normal and abnormal left ventricular systolic function that might be useful clinically in patients without regional wall-motion abnormalities. However, in patients with important segmental wall-motion abnormalities during systole, left ventricular longitudinal shortening is an imperfect surrogate for ejection fraction.

Echocardiography, Doppler, Pulsed↗
PubMed2004

Doppler tissue imaging analysis of ventricular function after surgical and transcatheter closure of atrial septal defect.

The long-term ventricular function of children after surgical and transcatheter closure of secundum atrial septal defects was assessed by Doppler tissue imaging and compared with that of age-matched controls. Long-term right ventricular function was impaired in patients after surgical repair, as reflected by decreased systolic and diastolic tricuspid annular velocities and an increased Tei index. In contrast, right ventricular function was preserved after transcatheter device closure.

Adolescent↗
PubMed1988

Increasing precordial QRS voltage correlates with improvement in left ventricular function following anterior myocardial infarction.

To evaluate whether changes in QRS voltage reflect changes in left ventricular function after myocardial infarction, 28 patients were studied following anterior myocardial infarction. Two-dimensional echocardiograms and 12-lead electrocardiograms were obtained during the acute phase of the infarction and again after at least 30 days of recovery (mean, 8 +/- 8 months). At follow-up, 11 patients (group A) showed improvement in left ventricular systolic function; 9 had increased net QRS voltage in V1-6 and 8 in V1-4. No improvement in ventricular function was found in 17 patients (group B); 7 had increased QRS voltage in V1-6 (p less than 0.05 vs group A) and only 5 in V1-4 (p less than 0.05 vs group A). For detection of improved left ventricular function, the sensitivity, specificity, and predictive value of the change in net QRS voltage for leads V1-6 was 82%, 59%, and 56% respectively, and for leads V1-4 was 73%, 71%, and 62% respectively. Neither R wave voltage, Q wave voltage, nor the total number of Q waves was reliable for identifying patients with improving left ventricular function. Thus, increasing net QRS voltage in the precordial electrocardiographic leads during long-term follow-up after anterior myocardial infarction correlates with and has a reasonable sensitivity for detection of improvement in left ventricular systolic performance.

Adult↗
PubMed1977

Preclinical abnormaltiy of left ventricular function in chronic alcoholics.

Left ventricular function of a sample of subjects with chronic alcohol intake, in the form of wine, and without clinical or electrocardiographic signs of heart disease was compared with that of a sample of normal control subjects using non-invasive polygraphic recordings. The statistical analysis has shown significant prolongation of PEP, PEPI, an increase in PEP/LVET, and a shortening of LVET and LVETI in the alcoholic subjects compared with the controls. All these abnormalities may be ascribed to left ventricular malfunction.

Adult↗
PubMed1986

[Acute effect of the cardioselective beta-1-partial agonist, Corwin, on ventricular function and myocardial oxygen consumption in patients with dilated cardiomyopathy].

The effects on left ventricular function and myocardial metabolism of Corwin (ICI 118,587), a selective beta-1 partial agonist, were evaluated in 12 patients with dilated cardiomyopathy. All patients were in sinus rhythm at the time of cardiac catheterization. Immediately before and 20 minutes after intravenous administration of 0.2 mg/kg Corwin over 2 minutes, high-fidelity left ventricular pressures and thermodilution coronary sinus blood flow were recorded along with ventriculograms in the 30 degrees right anterior oblique projection. In 11 patients, Corwin resulted in no change in heart rate, a fall in left ventricular end-diastolic pressure, a rise in left ventricular systolic pressure and an increase in cardiac index. There was a rise in both peak positive and peak negative dP/dt. End-diastolic and end-systolic volume indices fell, and ejection fraction rose. There was an increase in coronary sinus blood flow and a small rise in myocardial oxygen consumption. In contrast to these results in the group as a whole, in one patient Corwin produced depression of both systolic and diastolic left ventricular function. We conclude that, in many patients with dilated cardiomyopathy, Corwin produces an improvement in systolic and diastolic left ventricular function while at the same time only slightly increasing myocardial oxygen demand. In some patients, however, Corwin may result in a significant worsening of left ventricular performance due to its antagonistic effects.

Adrenergic beta-Agonists↗
PubMed1997

Contractile reserve in patients with peripartum cardiomyopathy and recovered left ventricular function.

OBJECTIVES: Peripartum cardiomyopathy is a rare complication of pregnancy. Thirty percent of patients with this disorder are reported to recover baseline ventricular function within 6 months of delivery, but the ability of these ventricles to respond to hemodynamic stress is unknown. The aim of this investigation was to quantitatively assess the contractile reserve of patients with a history of peripartum cardiomyopathy and recovered left ventricular function. STUDY DESIGN: Baseline left ventricular contractility was assessed by use of the load and heart rate-independent relationship between end-systolic stress and rate-corrected velocity of fiber shortening. Data were acquired from "recovered" patients (10.5 +/- 11.6 months after delivery) and compared with data from matched nonpregnant controls with use of two-dimensionally targeted M-mode echocardiography and calibrated subclavian pulse tracings that were recorded over a wide range of afterloads (end-systolic stress) generated by methoxamine (1 mg/min) infusion. Contractile reserve was assessed by a dobutamine challenge (5 micrograms/kg/min) and quantified as the vertical deviation of the dobutamine end-systolic stress minus the corrected velocity of fiber shortening data point from the baseline contractility line. RESULTS: Patients with peripartum cardiomyopathy and matched controls had normal baseline heart rates, blood pressures, ventricular dimensions, and left ventricular function. Contractile reserve, however, was reduced in patients with recovered peripartum cardiomyopathy (0.30 +/- 0.12 vs 0.17 +/- 0.04 circ/sec, p < 0.03). CONCLUSIONS: Women with a history of peripartum cardiomyopathy who have regained normal resting left ventricular size and performance have decreased contractile reserve revealed by the use of a dobutamine challenge test. Ventricles of these women may respond suboptimally to hemodynamic stress in spite of evidence of recovery by routine echocardiographic evaluation.

Adrenergic beta-Agonists↗
PubMedDate not supplied

Course of right and left ventricular function in patients with pulmonary insufficiency after repair of Tetralogy of Fallot.

Surgical repair of tetralogy of Fallot (TOF) frequently results in pulmonary valve insufficiency. Nevertheless, no serial information is available on the long-term impact of the valvular insufficiency on right and left ventricular function. Right and left ventricular ejection fraction was measured serially by radionuclide angiocardiography in 21 patients with at least moderate pulmonary insufficiency after repair of TOF. A baseline study was obtained an average of 1.2 years after repair, and a follow-up study was performed an average of 10.2 years after surgery. Changes in ventricular function over time and deviations from the normal range were analyzed. At baseline evaluation the mean right ventricular ejection fraction (RVEF; 0.52 +/- 0.10) and left ventricular ejection fraction (LVEF; 0.68 +/- 0.10) were normal. At the time of follow-up the mean RVEF had significantly decreased to 0.45 +/- 0.09 (p < 0.01). The mean LVEF had decreased to 0.60 +/- 0.11 (p < 0.02). This change was independent of the RVEF (r = -0.13). Eleven patients (52%) had an abnormal RVEF or LVEF at follow-up. Nineteen patients (90%) showed a decrease of 0.05 or more in RVEF, LVEF, or both between studies. These data suggest a negative impact of long-standing pulmonary insufficiency on right and left ventricular systolic function after repair of TOF. Therefore, continued surveillance of biventricular function in this patient population appears warranted.

Child↗
PubMed1989

Mitral valve annuloplasty: the effect of the type on left ventricular function.

This study was undertaken to determine whether rigid-ring annuloplasty and flexible-ring annuloplasty have the same effect on left ventricular function in patients with chronic mitral regurgitation secondary to degenerative disease of the mitral valve. Twenty-five patients who underwent isolated mitral valve repair and required annuloplasty were randomized into two groups: rigid-ring and flexible-ring annuloplasty. Left ventricular function was assessed by echocardiography and radionuclide angiography on the day before operation and 2 to 3 months later. Preoperative left ventricular function was similar in the two groups of patients. Postoperatively, left ventricular end-diastolic diameter and volume decreased significantly in both groups. The left ventricular end-systolic diameter and volume decreased significantly only in patients with a flexible annuloplasty ring. Left ventricular systolic function as assessed by pressure-volume relationships was significantly better in patients with a flexible ring (p less than 0.02 by analysis of covariance), and left ventricular performance measured by stroke volume-end-diastolic volume relationships was also better in these patients (p less than 0.05 by analysis of covariance). These data indicate that patients with a flexible annuloplasty ring have better left ventricular systolic function than patients with a rigid annuloplasty ring 2 to 3 months after mitral valve reconstruction for chronic mitral regurgitation secondary to degenerative disease of the mitral valve.

Adult↗
PubMed1992

Application of a continuous ventricular function monitor with miniature cadmium telluride detector to patients with coronary artery bypass grafting.

A continuous ventricular function monitor with a miniature cadmium telluride detector was evaluated and applied to patients with coronary bypass surgery (CABG). Ejection fraction (EF) at rest and change in EF from rest to exercise and postexercise (Y) measured with the device correlated with that of the gamma camera (X) (Y = 0.86x + 6.8(%), r = 0.87, n = 110, p less than 0.001, and Y = 0.96x + 0.4(%), r = 0.90, n = 37, p less than 0.001 respectively). Left ventricular function during and after supine ergometer exercise was monitored in 54 patients before and after CABG. The EF change from baseline to peak exercise improved from -5.9% +/- 8.9% before CABG to 7.2% +/- 7.9% after CABG (p less than 0.001). In all patients but two, a rapid EF increase just after exercise over baseline EF was observed. This EF "overshoot" during recovery increased from 11.5% +/- 6.5% to 16.4% +/- 6.0% (p less than 0.001) after CABG. The time from the cessation of exercise to EF overshoot decreased from 153 +/- 80 sec to 76 +/- 49 sec (p less than 0.001) after CABG. The continuous ventricular function monitor with a miniature cadmium telluride detector is able to measure EF reliably. Following successful aortocoronary bypass, EF response during exercise improved and the EF overshoot in the recovery phase became faster and higher.

Cadmium↗
PubMed1982

Perioperative protection of the myocardium in patients with impaired ventricular function.

Seventeen patients with poor ventricular function and severe coronary artery obstruction were operated on employing hypothermic potassium cardioplegic solution for myocardial preservation. Preoperatively and postoperatively, serial hemodynamics, electrocardiograms (ECG), MB-CPK studies, and technetium pyrophosphate scans were obtained for all patients. All ECGs and scans were negative for perioperative infarction. Peak MB-CPK levels were 40 +/- 25 units per liter. Two patients had MB-CPK levels suggestive of perioperative myocardial infarction. The preoperative cardiac index was 2.8 +/- 0.8 L/min/m2 and remained the same in the perioperative period. Stroke work index and total peripheral resistance were within normal range and remained constant throughout the period of study. Three patients required epinephrine (0.5 micrograms per minute) during the first 6 hours postoperatively, and in 2 patients an intraaortic balloon was inserted prophylactically and removed on the second postoperative day. Good myocardial preservation can be achieved in patients with severe coronary artery obstruction and preexisting left ventricular dysfunction using hypothermic potassium cardioplegic solution.

Aged↗
PubMed1988

Early recovery of left ventricular function after thrombolytic therapy for acute myocardial infarction: an important determinant of survival.

Thrombolytic therapy for acute myocardial infarction reduces early mortality, but full recovery of left ventricular function after reperfusion is delayed. Therefore, the relations among reperfusion, survival and the time course of left ventricular functional recovery were examined in 226 patients treated with intracoronary streptokinase; 77% (134 patients) had sustained reperfusion and 31 patients had no reperfusion or had reocclusion by day 3. Wall motion was measured from contrast ventriculograms performed in the acute period and 3 days later in the central and peripheral infarct regions and the noninfarct region by the centerline method in 165 patients. Patients with reperfusion had better survival (p less than 0.05, mean follow-up 4.5 years) and a higher ejection fraction at 3 days (52 +/- 12 versus 46 +/- 10%, p less than 0.02) attributable to a significantly different change in peripheral infarct region function between the acute and 3 day studies (0.1 +/- 1.0 versus -0.3 +/- 0.9 SD, p less than 0.05). These early functional changes were significant in patients with anterior myocardial infarction and showed similar trends in those with inferior myocardial infarction. On Cox regression analysis, function measured at 3 days was more predictive of survival than was function measured acutely (chi square for acute ejection fraction = 11.48 versus 24.59 at 3 days). Although, as previously reported, greater than 45% of total recovery of left ventricular function occurs later, the ejection fraction achieved by day 3 is already predictive of survival. Thus, the mechanism by which successful thrombolytic therapy enhances survival is improvement of regional and global left ventricular function early after acute myocardial infarction.

Coronary Circulation↗
PubMed1982

Mitral valve replacement in children. Comparative study of pre- and postoperative haemodynamics and left ventricular function.

Haemodynamic variables and left ventricular function were studied before and after mitral valve replacement in 44 children age 3 to 17 years (mean 11.9 years). Thirty-nine Starr-Edwards prostheses and five Hancock prostheses were used; postoperative study took place two to six months (mean 3.9 months) after operation. Pulmonary hypertension was present preoperatively in most patients, with mean pulmonary artery pressures of 18 to 75 (mean 46.5 mmHg). Postoperatively there was a pronounced drop in pressure to a mean value of 25.6 mmHg, partially explained by a decrease in pulmonary capillary wedge pressure. Pulmonary arteriolar resistance, however, also decreased conspicuously from an average of 590 dynes s cm-5 m-2 preoperatively to 282 dynes s cm-5 m-2 postoperatively. A return to normal resistance was seen in every case when preoperative resistance did not exceed 650 dynes s cm-5 m-2; above this threshold some degree of pulmonary hypertension often persisted. The residual gradient across the prosthetic valve was slightly higher for the Hancock than for the Starr-Edwards prosthesis (mean 8.7 mmHg, vs mean 6.9 mmHg). The left ventricular end-diastolic volume was much increased before surgery, with a mean value of 190 ml/m2; it decreased conspicuously after operation to 103 ml/m2. The left ventricular ejection fraction ranged from 40% to 76% (mean 57%) before operation; there was no significant change after operation, with values ranging from 40% to 73%. This left ventricular dysfunction is probably the result of myocardial injury caused by a chronic volume overload and the sequelae of rheumatic carditis.

Adolescent↗
PubMed1987

Exercise radionuclide assessment of left ventricular function before and after coronary bypass surgery.

The effects of elective saphenous vein coronary artery bypass surgery on left ventricular ejection fraction were assessed by using exercise first-pass radionuclide angiography in 66 consecutive patients. All patients with left main coronary artery or concomitant valvular disease were eliminated from the study. Before surgery, 7 patients had normal postexercise left ventricular function (Group 1), 33 had normal resting left ventricular function with an abnormal response to exercise (Group 2), and 26 had an abnormal resting left ventricular ejection fraction with an abnormal response to exercise (Group 3). Following surgery, patients in all three groups had no change in mean resting left ventricular ejection fraction; however, patients in Groups 2 and 3 had significant improvement in mean postexercise left ventricular ejection fraction (p less than 0.0001 and p less than 0.0054 respectively), whereas patients in Group 1 did not. Previous studies reported improvement in postexercise ejection fraction in patients with reduced resting left ventricular function and with an ischemic response to exercise (Group 3). But this is the first study to confirm improvement in postexercise function in patients with normal resting function and an ischemic response to exercise (Group 2).

Adult↗
PubMed1996

Analysis of right ventricular function during bypass of the left side of the heart by afterload alterations in both normal and failing hearts.

This study investigated the mechanism of right ventricular failure during bypass of the left side of the heart by precisely assessing right ventricular function with use of a conductance catheter. Bypass of the left side of the heart was established with a centrifugal pump in 10 mongrel dogs weighing 11 to 19 kg. Right ventricular function during left heart bypass was evaluated by two parameters that were both derived from measurement of relative change in right ventricular volume by the conductance catheter technique. One parameter was the right ventricular end-systolic pressure-volume relationship as a load-independent index, and the other was the peak right ventricular pressure-right ventricular stroke volume relationship as a "force-velocity relationship." These parameters were measured in both normal and failing hearts while afterload was increased by bilateral intrapulmonary balloon inflation. Moreover, changes in these relationships were observed by varying assist ratios of left heart bypass from 0% to 100%. Failing heart models were induced by normothermic aortic clamping for 20 minutes. The right ventricular end-systolic pressure-volume relationship in normal hearts did not change, irrespective of the assist ratio of left heart bypass, whereas that in failing hearts decreased from 4.25 +/- 1.41 mm Hg/ml without bypass of the left side of the heart to 3.53 +/- 1.30 mm Hg/ml after 100% assist of left heart bypass (p < 0.05). In the peak right ventricular pressure-right ventricular stroke volume relationship, right ventricular stroke volume was almost constant in normal hearts when afterload was increased regardless of the assist ratio of left heart bypass. Moreover, right ventricular stroke volume was maintained at a higher level during bypass of the left side of the heart compared with that without left heart bypass. However, that slope of the relationship in failing hearts was inversely linear and became significantly steeper after 100% assist of bypass of the left side of the heart compared with that without left heart bypass (-0.131 +/- 0.042 versus -0.051 +/- 0.038, p < 0.005). Therefore ++these two slopes of the relationship intersected at a point that was considered the critical point of afterload during bypass of the left side of the heart. In other words, right ventricular stroke volume was decreased by 100% left heart bypass above the critical point of afterload. In conclusion, this study demonstrates not only that bypass of the left side of the heart results in an increase in right ventricular stroke volume in both normal and failing hearts at the physiologic range of afterload, but also that right ventricular function against higher afterload is impaired by 100% assist of bypass of the left side of the heart in failing hearts.

Animals↗
PubMed1989

Value of normal electrocardiographic findings in predicting resting left ventricular function in patients with chest pain and suspected coronary artery disease.

PURPOSE: Characterization of left ventricular function is important in managing patients with coronary artery disease. Although many methods are available to assess left ventricular function, most are either expensive, invasive, or both. In this study, we examined the ability of normal or near-normal resting electrocardiographic findings to predict resting left ventricular ejection fraction, measured by resting radionuclide angiography, in 874 patients with chest pain and suspected coronary artery disease. PATIENTS AND METHODS: A retrospective review was undertaken of 4,410 Mayo Clinic patients who underwent rest and exercise radionuclide ventriculography for the evaluation of chest pain and known or suspected coronary artery disease; of these, 874 patients met the inclusion criteria for the current study. A 15-lead electrocardiogram, which was interpreted by the cardiologist or cardiology trainee working in the laboratory, was obtained at the same evaluation as the radionuclide study. RESULTS: In 590 patients with no previous history of a myocardial infarction and entirely normal resting electrocardiographic results without nonspecific ST-T wave abnormalities, the mean left ventricular ejection fraction was 0.63 +/- 0.004, and 559 patients (95%) had a normal resting ejection fraction (defined as 0.50 or more). Both nonspecific ST-T wave abnormalities (p less than 0.001) and, to a lesser degree, a history of myocardial infarction (p = 0.06) were independent predictors of an abnormal resting ejection fraction. In 185 patients with nonspecific ST-T wave abnormalities and no history of myocardial infarction, the mean left ventricular ejection fraction was 0.61 +/- 0.009, and 85% had a normal resting ejection fraction. In 36 patients with nonspecific ST-T wave abnormalities and a history of myocardial infarction, the mean left ventricular ejection fraction was 0.53 +/- 0.021, and 72% had a normal resting ejection fraction. CONCLUSION: Thus, an entirely normal result on a resting 12-lead electrocardiogram in patients with suspected coronary disease but no history of a previous myocardial infarction is a reliable (95%) predictor of normal left ventricular function. If nonspecific ST-T wave abnormalities are noted, particularly if there is a history of a previous infarction, the predictive value of the electrocardiographic findings is diminished.

Angina Pectoris↗
PubMedDate not supplied

Effect of bisoprolol on right ventricular function and brain natriuretic peptide in patients with heart failure.

Beta-blocker use improves left ventricular ejection fraction (LVEF) in patients with heart failure. A similar effect of b blockers on right ventricular function has been proposed, although the effect of bisoprolol, a highly selective b-1 blocker, on right ventricular function has not been assessed. This study investigated the short-term effect of bisoprolol on right ventricular function in chronic heart failure patients. A cohort of 30 heart failure patients who were not taking b blockers at baseline was studied prospectively. Right ventricular ejection fraction (RVEF) and LVEF were measured at both baseline and 4 months by radionuclide angiography. Bisoprolol was up-titrated during four monthly visits by a preestablished protocol to a target dose of 10 mg/d. The dose of vasodilators was not changed. Quality of life and brain natriuretic peptide level were assessed. Mean age was 62.7+/-14.3 years. Baseline RVEF was 30.7%+/-6.3% and baseline LVEF was 21.7%+/-9.4%. Mean bisoprolol dose reached was 5.3+/-3.9 mg daily. At 4 months, RVEF significantly increased by 7.1% (95% confidence interval, 3.9-10.2; p=0.0001) and LVEF also increased significantly by 7.9% (95% confidence interval, 4.0%-11.9%; p=0.0003). Quality-of-life score improved from 42.8 to 30.8 (p=0.047). No correlation was found between brain natriuretic peptide levels and RVEF. Bisoprolol treatment for 4 months resulted in a significant improvement of RVEF, which paralleled the improvement of LVEF.

Adrenergic beta-Antagonists↗
PubMed1987

Ventricular function after atrial cardioplegia.

Continuous retrograde coronary sinus cardioplegia (CSCP) has previously been carefully evaluated experimentally and shown to be efficacious during ischemia, even in the presence of coronary lesions and in the hypertrophied state. A new technique of retrograde cardioplegia delivery through the right atrium, using right ventricular distension and pressures of 60 mm Hg, has recently been described with excellent clinical results. This study was designed to specifically examine right ventricular function after atrial cardioplegia and acute passive right ventricular distension. CSCP (n = 10) was compared with cardioplegia delivered through the right atrium both continuously (n = 10) and intermittently (n = 8). When ventricular function was examined with the use of the load-independent relationship of stroke work vs end-diastolic length, there was a profound deterioration of right ventricular function in both atrial cardioplegia groups (44% and 37% of control values, respectively) after 1 hr of reperfusion. In contrast, biventricular function was fully preserved in the CSCP group 1 hr after reperfusion. Left ventricular function measured at the end of reperfusion was preserved in all three groups. Right ventricular ATP levels were slightly but significantly depressed in all groups and in the atrial cardioplegia groups, this metabolic change was also seen in the left ventricle. These metabolic and hemodynamic data may reflect the inability of atrial cardioplegia to cool the myocardium below 16 degrees C. Postoperative right ventricular dysfunction may be more common than has been previously thought when atrial cardioplegia is used, particularly in the absence of topical cooling.

Adenine Nucleotides↗