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PubMed1989

Medical and surgical management of early Q wave myocardial infarction. II. Effects on mortality and global and regional left ventricular function at 10 or more years of follow-up.

To determine the long-term effect of surgical reperfusion on survival and left ventricular function of patients with anterior and inferior Q wave myocardial infarction, 387 patients were followed up for greater than or equal to 10 years after early Q wave infarction. In the anterior infarction group, 102 received conventional therapy and 101 underwent surgical reperfusion. The overall hospital mortality rate in the medically and surgically treated patients was different (16.7% [17 of 102] versus 6.9% [7 of 101], p less than 0.05). The cumulative 13 year actuarial mortality rate widened between the anterior medical and surgical groups (54% versus 31%, p = 0.0003) by the adjusted Cox proportional hazards model. The hospital mortality rate with early reperfusion (that is, less than or equal to 6 h of symptom onset) was 2% (1 of 51), whereas the mortality rate with late reperfusion was 12% (6 of 50). The 13 year actuarial cumulative mortality rate was significantly lower in both the early and late reperfusion groups (30% and 33%, respectively) than in the conventional therapy group (54%, p = 0.0006). The mortality rate in patients receiving surgery after surviving initial medical therapy was 50% (15 of 30). In the survivors of anterior Q wave myocardial infarction, improved global ejection fraction was seen in the patients undergoing early (54 +/- 13%) and late (50 +/- 10%) surgery relative to those receiving conventional therapy (43 +/- 11%, p less than 0.05). Only the early reperfusion group had better regional function of the anterior wall than that of the conventional therapy group. Thus, ventricular function correlated with improved long-term survival. In the patients with inferior Q wave myocardial infarction, the overall hospital mortality rate in the medical and surgical groups was not different (6.1% [6 of 98] versus 4.6% [6 of 86], p = NS). Likewise, the 13 year actuarial cumulative mortality rate was not different between the medical and surgical groups overall (32% versus 30%, p = 0.29) by the adjusted Cox proportional hazards model. The hospital mortality rate in the early reperfusion group was lower than that in the late reperfusion group (2.0% [1 of 49] versus 8.1% [3 of 37], p = NS). The 13 year actuarial cumulative mortality rate was lower in the early surgical group compared with that in the medical group (19% versus 32%, p = 0.04). The late surgical group had a similar 13 year actuarial cumulative mortality rate to that of the medical group (47% versus 32%, respectively, p = 0.47).(ABSTRACT TRUNCATED AT 400 WORDS)

Cardiac Catheterization↗
PubMed1986

Quantitative analysis of left ventricular function by cold pressor two-dimensional echocardiography in patients with coronary artery disease.

Quantitative assessment of left ventricular function in patients with coronary artery disease was made by computer analysis of two-dimensional echocardiography performed during a cold pressor test. Short-axis cross-sectional images of the left ventricle at the levels of the mitral valve and chordae tendineae were recorded by a phase array sector scanner in 12 patients with coronary artery disease and 11 normal controls. Endocardial outlines at end-diastole and end-systole were traced and analyzed by a computer system. The short-axis cross-sectional images were divided into octants and were analyzed. The segmental area and its changes during the cardiac cycle were measured and calculated for each octant. Regional function of the left ventricle was evaluated by percent changes of segmental area. The regional segmental area changes in patients with coronary artery disease were compared with those in normal controls. Similar increments were achieved in rate pressure product in the 2 groups. In relation to the perfusing coronary arteries, 8 segments were integrated arbitrarily into 3 walls (anteroseptal wall, lateral wall, and posterior wall and posterior septum). The cold pressor test induced wall motion abnormalities in 12 of 16 walls which were supplied by stenosed coronary arteries. In contrast, wall motion abnormalities were detected in only 5 of 38 walls which were supplied by coronary arteries without significant stenotic lesions. The sensitivity of cold pressor test-induced wall motion abnormalities in detecting coronary artery disease was 75% and the specificity was 87%. No serious complications were encountered in this study. In conclusion, computer-aided cold pressor two-dimensional echocardiography is a safe and sensitive method for the assessment of left ventricular function and diagnosis of coronary artery disease.

Adult↗
PubMed1985

Valvular pulmonary stenosis. Natural history and right ventricular function in infants and children.

The purpose of this study was the analysis of natural history and right ventricular function of infants and children with valvular pulmonary stenosis. Available for assessment were the pressures in the right ventricle and pulmonary artery in 5 infants and 13 children obtained at two cardiac catheterizations, performed at intervals of 2 to 12 years (mean: 6.5 years) apart, as well as quantitative angiocardiographic data in another group of 38 children. There was no change in the pressure gradient between the right ventricle and pulmonary artery (PG) between the two catheterizations for those with an initial PG of less than 50 mmHg; but a mean increase of 8.6 mmHg year-1 occurred in those with an initial PG of more than 50 mmHg. There were good correlations between increase of PG and the first (r = 0.704) and the second (r = 0.904) catheterizations. End diastolic and stroke volume were normal while end-systolic volume was smaller (P less than 0.01) and ejection fraction greater (P less than 0.01) than normal. The natural history of children with a PG of more than 50 mmHg seems to be different from that with a PG of less than 50 mmHg. In the former group the increase of PG is rapid while PG in the latter does not change over many years. Right ventricular function is usually not impaired in patients with moderate and severe valvular pulmonary stenosis in the pediatric age group.

Angiocardiography↗
PubMedDate not supplied

[Chest pain syndrome in normal or non-diagnostic conventional ECG at the emergency service. Assessment with myocardial perfusion (SPECT) and ventricular function (Gated-SPECT)].

The arrival of a patient with chest pain syndrome (precordial) to the emergency represents a diagnostic challenge for the physician. Around 6 million persons are seen each year at the Emergency units in the USA. More than half of the patients are admitted for their cardiac evaluation. Its cardiac origin is confirmed in 10 to 15%, and about 15% of them develop myocardial infarction. However, 5 to 10% of patients are dismissed and develop myocardial infarction during the next 48 h. The diagnosis of the infarct is inadvertent and/or patients is not hospitalized in 2 to 8%. The mortality rate is duplicated in none hospitalized patients. Frequently, a conservative observation conduct and/or diagnostic expectation is taken, with the consequent saturation of the intensive care unit that looses its critical character and avoids quick mobilization of the patient with an increase in costs. The clinical judgment, a meticulous clinical history, and careful physical examination play a key role in the differential diagnosis of the precordial pain syndrome; however, pain can be atypical, absent or manifest as an equivalent of pain, which does not exclude the diagnosis of myocardial infarction or ischemia. Likewise, chest pain in the presence of a normal conventional ECG at rest, non-diagnostic or with minimal variations, does not rule out the possibility of a coronary obstruction and does not mean that the pain is not of coronary origin. Other characteristics of the ECG, such as T wave and ST segment alterations, bundle branch block (BBB), LV hypertrophy, interpretation discrepancies, can pose doubts or mistakes in the diagnosis. Although its diagnostic information is essential, other non-invasive laboratory tests are needed, such as the treadmill stress ECG, serial bioenzymatic markers, and myocardial perfusion scintigraphy (SPECT and Gated-SPECT) at rest or under physical or pharmacologic stress. The advantages and disadvantages of the stress ECG, the echocardiography, magnetic resonance and PET are mentioned. The advantages of the SPECT and Gated-SPECT in the diagnosis and prognosis are: 1) great diagnostic objectivity; 2) high sensitivity and specificity; 3) diagnosis does not depend on evolution time of the ischemia and/or infarction, since SPECT diagnoses the initial primary modifications of ischemia; 4) diagnosis is achieved within the established limit of time, in less than 4 to 6 hours. The designed protocols allow to obtain the diagnosis between 30 min and 1:30 h; 5) assesses the myocardium at risk; 6) stratifies the risk and prognosis; 7) defines the site and 8) the involved coronary artery(les); 9) provides the functional significance of the anatomic obstruction; 10) quantifies the ventricular function, i.e., ejection fraction, systolic and diastolic volumes, systolic thickening, ventricular failure signs; 11) provides three-dimensional visualization of the mobility of the left ventricular wall; 12) diagnoses simultaneously the associated presence of ischemia and/or infarction of the right ventricle; 13) its high negative predictive value allows to dismiss immediately and with a great safety margin those patients in whom SPECT revealed normal perfusion; 14) costs are reduced without adversely compromising the safety of the patients. We describe the algorithm used as guideline for the early diagnosis in the presence or absence of ischemic heart disease in the patient with precordial or chest pain syndrome with normal or non-diagnostic ECG at arrival to the emergency ward. It is necessary to modified the clinical educational patterns and to revaluate the advantages and limitations of the clinical history, physical exploration, as well as of the conventional ECG at rest and other diagnostic methods used specifically in relation to the chest pain syndrome with a normal or non diagnostic conventional ECG. SPECT and Gated-SPECT scintigraphy is considered as the best individual and isolated non-invasive test for the diagnostic solution of the precordial syndrome at the Emergency Unit.

Algorithms↗
PubMed1988

Effect of isolated right ventricular outflow obstruction on left ventricular function in infants.

Resting left ventricular (LV) function was evaluated in 29 infants with isolated right ventricular (RV) outflow obstruction. Age-corrected cardiac index was significantly inversely correlated with the degree of obstruction (r = 0.59, p = 0.0001). Right ventricular hypertension resulted in septal displacement and altered LV geometry. The magnitude of RV outflow obstruction related closely to the degree of LV distortion. Septal displacement toward the LV free wall was associated with lower values for cardiac index, indexed LV end-diastolic volume, ejection fraction, ratio of early to atrial LV diastolic inflow and with a higher RV ejection fraction. The LV end-diastolic volume index and the ratio of early to atrial LV diastolic inflow correlated with the degree of obstruction and amount of septal displacement. Four infants evaluated during the development of supravalvar pulmonary stenosis demonstrated decreasing cardiac index during development of obstruction and significant increase in cardiac index after surgical relief. These findings indicate that significant RV outflow obstruction in infants is associated with a reversible alteration in LV function related to abnormal LV geometry and impaired LV diastolic filling.

Cardiac Output↗
PubMed1989

Errors in the determination of left ventricular functional parameters.

Gated blood-pool scans of the left ventricle are routinely employed for determination of the left ventricular ejection fraction. Recently, attempts have been made to evaluate other left ventricular functional parameters. These values include peak emptying rate (PER), time to peak emptying rate (TPER), peak filling rate (PFR), and time to peak filling rate (TPFR). In studying these parameters clinically, we identified many software errors and assumptions that impact on these values. These errors may also affect the determination of left ventricular ejection fraction (EF). We conclude that before any serious investigation of left ventricular functional parameters is undertaken, a detailed evaluation and standardization of the acquisition and edge detection algorithms must be performed.

Diagnostic Errors↗
PubMed1978

[Initial systolic ejection rate as a parameter of ventricular function in valvular heart disease (author's transl)].

In patients with valvular heart disease the initial systolic ejection rate was determined in an attempt to characterize ventricular function in pressure and volume overload. By means of left ventricular cineangiography, the volume change during the initial third of the ejection phase was determined and the mean ejection rate of this period was calculated. A total of 40 patients were examined, 7 patients without heart disease, 15 patients with pure aortic regurgitation, 9 patient with pure aortic stenosis and 9 patients with pure mitral regurgitation. In patients with pure aortic regurgitation and high-normal values for ejection fraction and mean velocity of circumferential fiber shortening (mVcf) a significant increase in initial systolic ejection rate when compared to the group of normals was observed. The distribution of the stroke volume for each third of the ejection phase corresponded to the normal pattern. In contrast, in patients with low-normal values for ejection fraction and mVcf, a decrease in the initial systolic ejection rate below the normal value was observed, along with a pathological distribution of the stroke volume during the ejection phase. This finding was also noted in all patients with pure mitral regurgitation and pure aortic stenosis. In aortic stenosis, the decline in initial systolic ejection rate was regarded as a consequence of the outflow tract obstruction, whereas in volume overload, this was regarded as a sign of a decline in ventricular function which is not recognized with global parameters such as ejection fraction and mVcf.

Angiocardiography↗
PubMed1999

Left ventricular function and perfusion from gated SPECT perfusion images: an integrated method.

UNLABELLED: A new technique for computing left ventricular function, including left ventricular volumes, mass and ejection fraction, has been developed. This method is a logical extension of the results of a standard perfusion quantification technique; thus, it allows integration of perfusion and functional information. METHODS: Anatomically based models of the endocardial and epicardial surfaces are generated using the myocardial samples for which perfusion values are quantified, for all frames in the cardiac cycle. With these surface points, left ventricular chamber volume and myocardial volume can be computed. A computer simulation was used to determine the sensitivity of the approach to the assumptions of the model. Validation of volume, mass and ejection fraction was performed with correlative MR studies, and ejection fraction and left ventricular volumes were further investigated using correlative first-pass studies. RESULTS: Automated processing was successful in 96% of the cases analyzed. End diastolic volume, end systolic volume, left ventricular mass and left ventricular ejection fraction correlated with MRI with r = 0.97, 0.99, 0.87, and 0.85, respectively. Ejection fraction from tomography correlated with first-pass values with r = 0.82, and end diastolic and end systolic volumes from tomography correlated with first-pass values with r = 0.85 and r = 0.91, respectively. CONCLUSION: The new integrated approach is accurate and robust for computing both perfusion and function from perfusion tomograms.

Computer Simulation↗
PubMed2003

[Influence of the beta-blocker nebivolol on left ventricular function in patients with chronic heart failure].

BACKGROUND: Sympathetic activity is a significant predictor of a poor prognosis in heart failure. beta-blockers such as carvedilol, metoprolol or bisoprolol have been shown to improve the prognosis of patients with heart failure. AIM: This pilot study examined the tolerability and effect of the new beta-blocker nebivolol on left ventricular ejection fraction in patients with chronic heart failure. PATIENTS AND METHODS: Twelve patients with an ejection fraction of 13-39% were included into a double-blind, placebo-controlled, randomized trial with nebivolol on top of a standard therapy. Exercise time, heart rate, left ventricular function, and tolerability were examined at baseline and after 3 months of orally administered nebivolol (2.5 mg and 5 mg, n = 6) or placebo (n = 6). RESULTS: Nebivolol was well tolerated and NYHA stage improved in four patients. Heart rate decreased while the maximal exercise duration and performance remained stable. Left ventricular function improved (ejection fraction: increase from 29.8 +/- 10.66% to 41.2 +/- 10.53%; p = 0.007) after 12 weeks of nebivolol whereas placebo did not improve cardiac function statistically significant. Left ventricular endsystolic diameter decreased from 56.5 +/- 9.40 mm to 50.2 +/- 9.43 mm in the nebivolol group (p < or = 0.02). CONCLUSION: These data indicate that nebivolol might improve cardiac function in patients with chronic heart failure.

Administration, Oral↗
PubMed1983

Frame by frame analysis of left ventricular function. Quantitative assessment of regional and temporal function.

We made a frame by frame analysis of the left ventricular cineangiogram to quantitate normal regional left ventricular function. Two different methods were used: contraction of the left ventricle towards a fixed point at the center of its long axis, and a pattern of contraction normal to the outline of the ventricle. Each method was used with and without correction for rotation and translational movement during systole. Left ventricular contraction and relaxation were represented graphically on a three-dimensional perspective plot and also using contour mapping techniques. The normal values and standard deviation were calculated for the extent, velocity and time course of ventricular contraction and relaxation in each region of the ventricle. The study provided a graphic visual display of the regional contractile pattern of the normal ventricle.

Adult↗
PubMed2004

Improved systolic ventricular function with normal myocardial mechanics in compensated cardiac hypertrophy.

There is still controversy about the relation between changes in myocardial contractile function and global left ventricular (LV) performance during stable concentric hypertrophy. To clarify this, we analyzed LV function in vivo and myocardial mechanics in vitro in rats with pressure overload-induced cardiac hypertrophy. Male Wistar rats (70 g) underwent ascending aortic stenosis for 8 weeks (group AAS, n = 9). LV performance was assessed by transthoracic echocardiography under anesthesia. Myocardial function was studied in isolated papillary muscle preparations during isometric contraction. The data were compared with age- and sex-matched sham-operated rats (group C, n = 9). LV weight-to-body weight ratio (C: 2.13 +/- 0.14 mg/g; AAS: 3.24 +/- 0.44 mg/g), LV relative wall thickness (C: 0.18 +/- 0.02; AAS: 0.33 +/- 0.09), and LV fractional shortening (C: 54 +/- 5%; AAS: 70 +/- 8%) were increased in group AAS (P < 0.05). Echocardiographic analysis also indicated a significant association (r = 0.74; P < 0.001) between the percent fractional shortening index and LV relative wall thickness. The performance of AAS isolated muscle revealed that active tension (C: 6.6 +/- 1.7 g/mm2; AAS: 6.5 +/- 1.5 g/mm2) and maximum rate of tension development (C: 69 +/- 21 g/mm2/s; AAS: 69 +/- 18 g/mm2/s) were not significantly different from group C (P > 0.05). In conclusion, compensated pressure-overload myocardial hypertrophy is associated with preserved myocardial function and increased ventricular performance. The improved LV function might be due to the ventricular remodeling characterized by an increased relative wall thickness.

Animals↗
PubMedDate not supplied

Serial assessment of left ventricular function during dobutamine stress by means of electrocardiography-gated myocardial SPECT: combination with dual-isotope myocardial perfusion SPECT for detection of ischemic heart disease.

BACKGROUND: Technetium-labeled myocardial perfusion tracers allow simultaneous assessment of myocardial perfusion and left ventricular function by electrocardiography (ECG)-gated myocardial single photon emission computed tomography (SPECT). The purpose of this study was to evaluate left ventricular performance during dobutamine stress by means of ECG-gated myocardial perfusion SPECT with short-time data collection. METHODS AND RESULTS: After administration of Tc-99m sestamibi or tetrofosmin (600-740 MBq), 67 patients with ischemic heart disease, including 35 with prior myocardial infarction, were examined by ECG-gated myocardial perfusion SPECT at rest and during dobutamine stress (at dosages of 4, 8, 12, 16, and 20 microg/kg/min, with increments every 8 minutes). The ECG-gated data collection time was 5 minutes for each dobutamine dosage. After acquisition of gated SPECT data at the highest dose, thallium 201 chloride (111 MBq) was injected, and dual-isotope SPECT was also performed to assess the myocardial ischemia. In 32 patients without prior myocardial infarction, the sensitivity of individual stenosed-vessel detection with dual-isotope perfusion SPECT, with wall motion abnormality obtained from gated SPECT, and with the combined method was 55.9%, 52.9%, and 73.5%, respectively, based on coronary angiography. ECG-gated SPECT during dobutamine infusion revealed regional wall motion abnormalities (worsening or biphasic response) in 19 (57.6%) of 33 infarcted areas with culprit coronary arterial stenosis. The prevalence of reversible perfusion defects on dual-isotope SPECT was higher in segments with wall motion abnormalities than in segments with normal wall motion response (89.5% vs 42.9%, P <.02). CONCLUSIONS: Myocardial perfusion and left ventricular function during dobutamine infusion were analyzed in a single examination by means of the combined method. This procedure has the potential to provide comprehensive information with which to evaluate patients with ischemic heart disease.

Blood Pressure↗
PubMed1993

Percutaneous transluminal coronary angioplasty in patients with severely depressed left ventricular function.

Among nearly 2,000 consecutive percutaneous transluminal coronary angioplasty (PTCA) patients, 42 patients (36 male, 6 female; mean age 60 +/- 11 years) with mainly unstable angina had ejection fractions of < or = 35% (mean 30 +/- 5%). All patients had previous myocardial infarctions; 31 (= 74%) had multivessel disease. Successful procedure was achieved in 35 of the 42 (= 83%) patients, 31 of 35 (= 89%) stenoses could be successfully dilated and 9 of 15 (= 60%) occlusions reopened. In-hospital mortality was 2.4%. Follow-up angiography in 22 of the 35 patients who had been successfully treated showed significant improvement of ejection fraction from 29 +/- 5 to 36 +/- 7%. At clinical follow-up 19 +/- 14 months (2-53 months) after the procedure, nearly all surviving patients were in anginal class I or II, 5 had died from cardiac and 1 from noncardiac causes. Thus, PTCA in patients with severely depressed left ventricular function shows acceptable acute results; attenuation of ventricular dysfunction and continued symptomatic improvement can be achieved. However, late outcome is significantly worse than in patients with normal ventricular function.

Adult↗
PubMed1983

[Intracoronary thrombolytic treatment with urokinase in myocardial infarct: clinical angiographic findings and effects on left ventricular function].

The effect of selective intracoronary thrombolysis was studied in 27 patients with evolving myocardial infarction. In the acute phase, angiography demonstrated complete occlusion in 22 cases (81,5%) (group A), and incomplete stenosis with diminished distal blood flow in 5 cases (18,5%) (group B). Urokinase was infused into the infarct-related coronary artery at a rate of 8000 u/min u/min until reperfusion was obtained and subsequently at a rate of 2-4000 u/min for 20-40 min. In group A, coronary recanalization was achieved in 18 of 22 patients (81,8%) (group A1), while in 4 patients (group A2) the procedure was unsuccessful. Group B patients showed no angiographic modifications following fibrinolytic therapy. Left ventricular function was studied during the acute phase (before and after therapy) in 9 patients; 22 patients were studied immediately after thrombolysis and before hospital discharge. Preliminary studies of patients in group A1 after reperfusion showed a decrease in telediastolic pressure from 18,9 to 24,4 mmHg and an increase in ejection fraction from 0,40 to 0,43 (p = ns). No modifications in these parameters were observed in group A2 or B. Follow-up examination of group A, revealed an increase in ejection fraction from 0,40 +/- 0,12 to 0,50 +/- 0,15 (p less than 0,05) and a decrease in the length of the akinetic segment from 6,49 +/- 2,4 to 4,40 +/- 1,35 (p less than 0.05). In group B, the ejection fraction increased from 0,41 +/- 0,06 to 0,50 +/- 0,04 (p less than 0.05) and the length of the akinetic segment decreased from 7,52 +/- 2,0 to 3,38 +/- 1,14 (p less than 0.05). On the contrary, in group A2, ejection fraction diminished from 0,39 +/- 0,06 to 0,34 +/- 0,07 and the length of the akinetic segment remained unchanged. Our results suggest that: A) coronary artery thrombosis is frequent in evolving myocardial infarction B) selective intracoronary thrombolysis and subsequent reperfusion of the infarcted area is readily obtainable with urokinase infusion C) no significant acute modifications of left ventricular function were observed D) 2-3 weeks after initial treatment, patients in which recanalization of an occluded vessel was achieved (group A1) and patients that presented with subocclusive stenosis and reduced blood flow (group B), showed an improvement in left ventricular function and a reduction in the akinetic area.

Adult↗
PubMed1982

Sequential study of left ventricular function in aortic valvular stenosis.

To assess the progression of aortic valvular gradients (AVG) and their relation to left ventricular function, 21 patients with aortic valvular stenosis were studied sequentially by cardiac catheterization and left ventriculography. All AVG were obtained from the left ventricle to ascending aortic pullback tracings. The ejection fraction and mean velocity of circumferential fiber shortening were obtained from left ventriculograms. A new onset of syncopal episode was helpful to predict the progression of AVG in five patients, but in others the progression of aortic stenosis was generally not predictable. The left ventricular contractility of these patients was usually normal, but seven patients exhibited the progressive impairment that was not proportional to the change of AVG and was clinically unrecognized. Also, the left ventricular function may deteriorate in the absence of progression of the aortic valvular gradient. Thus, serial hemodynamic studies could be indicated in patients with mild to moderate aortic stenosis even in the absence of new symptoms and signs.

Adult↗
PubMed2003

Assessment of left ventricular function during off-pump coronary artery bypass surgery.

Left ventricular function is commonly impaired following cardiopulmonary bypass and cardioplegic arrest. Off-pump coronary artery bypass surgery (OPCABG) offers promise of better myocardial protection, although the effect of multiple regional ischemic events on global myocardial function is unknown. Twenty-eight patients undergoing multivessel OPCABG were assessed with transesophageal echocardiography and pulmonary artery catheterization prior to and following revascularization. Both load-dependent and relatively load-independent measurements of systolic and diastolic performance were measured. Mean +/- SD age was 62+/-8.3 years, grafts performed were 3.8+/-1.6, and 28% of patients had fractional area change (FAC) <50%. Blood pressure was lower following OPCABG associated with a fall in systemic vascular resistance. There was no difference in measurements of systolic functional FAC, cardiac index, or afterload-corrected FAC. Diastolic function appeared to improve based on mitral inflow and pulmonary vein Doppler measurements, but this occurred at a significantly lower pulmonary capillary wedge pressure and end-diastolic area. No change in diastolic function was found using less load sensitive indices of diastolic function (color M-mode Doppler, tissue Doppler and instantaneous end-diastolic stiffness). Left ventricular systolic and diastolic function is preserved following multivessel OPCABG.

Catheterization, Swan-Ganz↗
PubMed2002

Celsior solution provides superior post-ischemic right ventricular function as compared with UW solution in a porcine heart transplantation model.

BACKGROUND: Use of the new cardioprotective Celsior solution has been suggested for organ preservation in cardiac transplantation, but selective data for right ventricular function, of special interest in the clinical setting, have not been evaluated. METHODS: Celsior solution was compared with the clinical standard University of Wisconsin solution (UW) in a porcine allogenic heart transplantation model with accurate isovolumic measurement of right ventricular (RV) function. RESULTS: Maximum RV developed pressures were significantly different between Celsior and UW groups (51.1 +/- 9.6 mm Hg vs 42.2 +/- 15.4 mm Hg after 1 hour, respectively, and 55.6 +/- 7.8 mm Hg vs 45.1 +/- 16.2 mm Hg after 2 hours, respectively; p = 0.02, 2-way analysis of variance). CONCLUSIONS: Celsior significantly improves post-ischemic right ventricular function when compared with UW solution in an experimental heart transplantation model.

Adenosine↗
PubMed1989

[Right ventricular function in retrograde cardioplegia for myocardial protection--an experimental study].

Anterior cardiac veins which are the main drainage vessels of the right ventricle drain directly into the right atrium. Therefore, the right ventricular wall may not be perfused effectively during open heart surgery by the use of retrograde cardioplegic method resulting in postoperative right ventricular dysfunction. Seventeen mongrel dogs were subjected to this study and were placed on cardiopulmonary bypass using a conventional heart-lung machine. Total aortic cross-clamping time was 60 minutes in all dogs. In Group I (n = 6), 4 degrees C St. Thomas' Hospital solution (15 ml/kg body weight) was injected into the aortic root by the use of a syringe. Cardioplegic solution was replenished every 20 minutes with a half of the initial dose (7.5 ml/kg body weight). Group II (n = 6) were the dogs with the retrograde cardioplegia in which 4 degrees C St. Thomas' Hospital solution (15 ml/kg body weight) was given retrogradely from the coronary sinus by the drip method at the height of 60 cm, and the replenishing dose and interval of cardioplegia were the same as Group I. Group III (n = 5) was the dogs treated with retrograde cardioplegia identical to Group II and the combined use of topical cooling with ice-slush. The hearts were resuscitated after 60 minutes of aortic cross-clamping. Right ventricular functions such as cardiac output, right atrial pressure, right ventricular end-diastolic pressure, right ventricular max dp/dt, and shortening fraction of the right ventricle were measured 15, 30, 45, and 60 minutes after cardiac resuscitation respectively. In Group II, right atrial pressure was significantly elevated from the control value 15 and 30 minutes after cardiac resuscitation. On the other hand, all indices of right ventricular functions in Group III showed insignificant changes. The present experimental study demonstrated the retrograde cardioplegic method could produce right ventricular perfusion resulting in right ventricular dysfunction early after cardiac resuscitation. This deleterious effect however could be prevented by the combined use of topical cooling of the right ventricle with ice-slush.

Animals↗