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PubMed1994

Hemodynamic effects of different modes of mechanical ventilation in acute cardiac and pulmonary failure: an experimental study.

OBJECTIVE: To determine the hemodynamic effects of four different modes of mechanical ventilation in an animal model of acute cardiac and pulmonary failure. DESIGN: Prospective, randomized, crossover design. SETTING: University research laboratory. SUBJECTS: Twelve piglets weighing 10 to 16 kg. INTERVENTIONS: The experimental protocol consisted of three stable 30-min periods: when ventricular and pulmonary functions were normal (control), after the induction of acute cardiac failure by the administration of a beta-adrenergic receptor blocker, and after pulmonary failure induced by repeated lung lavage. Modes of mechanical ventilation included controlled mechanical ventilation, high-frequency oscillation, synchronized high-frequency jet ventilation, and external negative pressure oscillation combined with pressure support ventilation. Each mode of respiratory support was randomly and sequentially applied to each animal with the assessment of cardiopulmonary function at the end of each period. MEASUREMENTS AND MAIN RESULTS: Continuous monitoring included electrocardiogram, right atrial, left ventricular end-diastolic, pulmonary arterial, intrathoracic aortic, arterial, esophageal, and transpulmonary pressures and arterial and mixed venous oxygen saturation measurements. In addition, cardiac output using the thermodilution technique was measured intermittently. Whereas in the control period cardiac index was significantly (p < .05) higher during synchronized high-frequency jet ventilation (193 +/- 19.3 mL/kg/min) than during controlled mechanical ventilation (151 +/- 12.1 mL/kg/min) and high-frequency oscillation (151 +/- 18.1 mL/kg/min), there was no significant hemodynamic difference between the four modes of mechanical ventilation in the cardiac and pulmonary failure periods. In the pulmonary failure period, transpulmonary pressure was significantly higher during high-frequency oscillation (7.1 +/- 1.6 mm Hg) than during controlled mechanical ventilation (5.6 +/- 0.6 mm Hg), high-frequency ventilation (4.1 +/- 0.4 mm Hg), and external negative pressure oscillation combined with pressure support ventilation (5.3 +/- 0.5 mm Hg). CONCLUSIONS: Synchronized high-frequency ventilation improves cardiac performance in control conditions. No hemodynamic difference is present between the four modes of mechanical ventilation in the cardiac and pulmonary failure periods. External negative pressure oscillation combined with pressure support ventilation has moderate hemodynamic advantages over controlled mechanical ventilation and high-frequency oscillation in different clinical settings, but it also results in a deterioration of pulmonary gas exchange during the pulmonary failure period.

Animals↗

PubMed1984

Aging and atrial electrophysiologic properties in man.

In order to assess the influence of age on atrial electrophysiologic properties, we studied 17 normal subjects, whose ages were homogeneously distributed between 17 and 78 years, measuring in each of them effective (ERP) and functional (FRP) refractory periods at 3 sites of the right atrium (high, middle and low in the lateral wall) at the same driven frequency (120/min). Twice threshold stimuli of 2 msec duration were applied. Dispersion of atrial refractoriness was measured as the longest minus the shortest refractory period. A significant direct correlation was observed between age and dispersion of atrial refractoriness (of ERP: r = 0.75, P less than 0.001; of FRP: r = 0.82, P less than 0.001). Moreover, age showed a significant direct correlation with refractoriness at high right atrium (ERP: r = 0.66, P less than 0.01; FRP: r = 0.76, P less than 0.001), but did not correlate with that at the other two sites. We suggest that ageing modifies atrial refractoriness in a non-uniform manner inducing a progressive increment of dispersion of atrial refractoriness. The impression is that a slow but continuous process takes place from juvenility to old age.

Adolescent↗

PubMed1989

Effects of a single dose of isosorbide-5-mononitrate on the left ventricular diastolic function in systemic hypertension.

The effect of a single dose of isosorbide-5-mononitrate on left ventricular (LV) diastolic function was assessed by radionuclide ventriculography in 18 hypertensive patients. The effect of the mononitrate on atrial filling also was assessed. As expected, there was a significant decrease in mean blood pressure (120 +/- 17 to 102 +/- 18 mm Hg, p less than 0.005). Global LV ejection fraction did not show a significant change, increasing slightly from 64 +/- 9 to 68 +/- 8% (difference not significant). The mononitrate prolonged the time to peak filling rate from 176 +/- 36 to 195 +/- 29 ms (p less than 0.0001). The percentage of time to peak filling rate from diastole also increased, from 46 to 53% (p less than 0.05), whereas the normalized peak filling rate did not change (2.36 +/- 0.6 to 2.31 +/- 0.6 end-diastolic volumes/s, difference not significant). This effect on LV diastolic function was closely related to a certain reduction in preload, as suggested by the reduction in mean left atrial filling (45 +/- 12 to 40 +/- 13 counts/s, p less than 0.005) and LV diastolic counts, suggesting that the "impairment" of diastolic function induced by nitrates is secondary to the reduction in venous return to the left atrium. The mononitrate did not affect the mean right atrial filling rate (50 +/- 12 to 52 +/- 13 counts/s) and the right ventricular end-diastolic counts, suggesting a primary vasodilatory effect of nitrates on the pulmonary vascular bed.

Adult↗

PubMed1993

Left ventricular diastolic dysfunction late after coarctation repair in childhood: influence of left ventricular hypertrophy.

OBJECTIVES: Left ventricular systolic and diastolic function were evaluated late after successful operation for aortic coarctation in childhood. BACKGROUND: Persistent arterial hypertension and left ventricular hypertrophy after coarctation repair might impair left ventricular function. METHODS: Biplane angiography and simultaneous high fidelity pressure measurements were performed in 12 patients 3 to 12 years postoperatively (residual pressure gradient 4 mm Hg). Eight patients were normotensive and four had borderline hypertension. Data at rest and after nitroprusside infusion (1.7 micrograms/kg per min) were evaluated and compared with data from 12 control subjects. RESULTS: Systolic left ventricular function (ejection fraction-end-systolic wall stress relation) was normal in all patients. However, left ventricular muscle mass (113 vs. 86 g/m2), right atrial pressure (5.2 vs. 1.9 mm Hg) and left ventricular end-diastolic pressure (16 vs. 11 mm Hg) were significantly higher in patients than in control subjects. There was a linear relation between muscle mass and left ventricular end-diastolic (r = 0.66, p < 0.001) or right atrial (r = 0.60, p < 0.01) pressure. Left ventricular relaxation and myocardial stiffness were normal. However, there was an upward shift of the diastolic pressure-volume curve when compared with control values, but this shift was reversed by the administration of nitroprusside. CONCLUSIONS: Systolic function is normal late after coarctation repair. However, diastolic function can be abnormal with an upward shift of the diastolic pressure-volume curve that is reversed by nitroprusside administration and is probably due to residual left ventricular hypertrophy.

Adolescent↗

PubMed2000

Atrial septal defect in adults. Thirty-eight-year follow-up of a surgically and a conservatively managed group.

This report describes the long-term (up to 38 years) outcome, in terms of mortality and cardiovascular morbidity, in a non-randomized clinical observation study of a surgically and a conservatively managed group of adult patients with shunt lesions at atrial level. Haemodynamic status was assessed at baseline and at repeat examination. Twelve patients underwent surgical repair of the lesion between these two heart catheterizations, resulting in a marked reduction in heart size and right ventricular systolic pressure. These changes were associated with improvement in functional class and a trend towards less risk of cerebrovascular incidents, but not atrial fibrillation, during follow-up. Among 12 patients not operated on between catheterizations, symptomatic deterioration was common, often necessitating later surgical repair. The results support the assumption that early surgery should be recommended for adults with a haemodynamically significant lesion, to reduce the risk of mortality and prevent symptomatic deterioration.

Adolescent↗

PubMed2001

Biatrial activation in isthmus-dependent atrial flutter.

BACKGROUND: The aim of this study was to determine the biatrial activation pattern in isthmus-dependent atrial flutter (AFL) to understand the functional interatrial connections and the activation pattern of the left atrium (LA). METHODS AND RESULTS: Biatrial activation was performed, using an electroanatomic mapping system, in 10 patients undergoing right atrial isthmus ablation for counterclockwise (n=7) or clockwise (n=3) AFL. The AFL circuit was peritricuspid and propagated slowly (0.5+/-0.2 m/s) through the isthmus. LA was activated by two wave fronts, with discrete breakthroughs in the superior, mid, or inferior atrial septum. The activation of LA overlapped 50+/-16% of the AFL cycle length. In counterclockwise AFL, at least one breakthrough was located in the inferior atrial septum. LA activation began immediately after the exit of the flutter wave from the isthmus and was directed inferosuperiorly in all patients, being synchronous with the atrial septal activation. The septal breakthroughs in patients with clockwise AFL were variably located. The direction of LA activation was superoinferior in 2 and inferosuperior in 1 patient. CONCLUSIONS: The circuit of isthmus-dependent AFL was entirely in the right atrium. LA activation was a bystander and followed trans-septal conduction across the inferior coronary sinus-LA connection, Bachmann's bundle, and/or fossa ovalis.

Atrial Flutter↗

PubMed1987

[Primary pulmonary hypertension in childhood--clinical course and morphologic correlations with particular reference to the endocrine heart].

This is a case report of a 13-year-old girl who developed clinical symptoms of primary pulmonary hypertension (PPH). The prognosis is determined by progressive overloading of the right heart. Tissue from both the right and the left atria was examined using immunohistochemical methods. Cardiodilatin/alpha-ANP (atrial natriuretic peptide)-producing myoendocrine cells were analysed. As recent investigations have shown, the atrium and especially the atrial appendages of the heart function as an endocrine organ which is stimulated by pressure and volume overload, and which produces a natriuretic and vasodilatory peptide hormone from myoendocrine cells. In our case we found a general hyperplasia of the myoendocrine cells of the right atrium which is interpreted as a secondary reaction towards an increasing overload. This also means a temporary compensation of the progressive obstruction of the small pulmonary arteries, initiated by vasodilatory heart peptides. These investigations are in agreement with those of other groups who found an increased production of cardiac hormones in atrial overload. In the perinuclear area, electron microscopy shows zones of autophagolysis and the typical specific atrial granules which account for a dysfunction of atrial myoendocrine cells, as seen in other cardiac diseases. Our results may contribute to a better understanding of the pathogenesis of PPH and may help in diagnosis and therapy.

Adolescent↗

PubMed1986

Echocardiographic evaluation of inferior vena cava wall motion and pulmonary flow velocity responses to sublingual nifedipine.

Echocardiographic and cardiac catheterization were used to test the effect of Nifedipine, sublingually administered, on the right heart function and pulmonary flow velocity and pressure in 25 cases. Systolic and mean pulmonary pressure, wedge pressure, mean right atrial and ventricular end-diastolic pressure, aortic pressure, and total pulmonary resistance decreased after Nifedipine in 10 patients who underwent diagnostic cardiac catheterization. While pulmonary flow velocity, expressed as the slope of the contrast echo lines on the pulmonary valve, increased as a mean value after Nifedipine, it showed different behaviour in single cases and thus failed to provide any reliable conclusion as to the effect of Nifedipine. Nifedipine slightly reduced the internal diameters of the inferior vena cava and significantly increased the values of collapsibility and emptying indexes and pulsation. The results confirm the beneficial effect of Nifedipine on right heart function and pulmonary bed. In addition, echocardiography is seen to be a valuable and reliable non-invasive means of testing the acute and chronic effects of either Nifedipine or other drugs on the right heart sections.

Adult↗

PubMed2006

Prevention of ventricular desynchronization by permanent para-Hisian pacing after atrioventricular node ablation in chronic atrial fibrillation: a crossover, blinded, randomized study versus apical right ventricular pacing.

OBJECTIVES: The aim of our study was to evaluate the feasibility, the safety, and hemodynamic improvements induced by permanent para-Hisian pacing in patients with chronic atrial fibrillation and narrow QRS who underwent atrioventricular (AV) node ablation. BACKGROUND: Right ventricular apical pacing, inducing asynchronous ventricular contraction, may impair cardiac function; permanent para-Hisian pacing could preserve interventricular synchrony and improve left ventricular function. METHODS: After AV node ablation, 16 patients were implanted with a dual-chamber pacemaker connected to a screw-in lead positioned in close proximity to the His bundle and to a right ventricular apical lead. Clinical and echocardiographic data were collected at baseline and after two randomized six-month periods (with para-Hisian and conventional pacing). RESULTS: During para-Hisian pacing, the interventricular electromechanical delay improved as well (34 +/- 18 ms) as during right apical pacing (47 +/- 19 ms), p < 0.05. Para-Hisian pacing allowed an improvement in New York Heart Association functional class (1.75 +/- 0.4 vs. 2.33 +/- 0.6 at baseline and 2.5 +/- 0.4 during apical pacing, p < 0.05 for both), in quality-of-life score (16.2 +/- 8.7 vs. 32.5 +/- 15.0 at baseline, p < 0.05), and in the 6-min walk test (431 +/- 73 m vs. 378 +/- 60 m at baseline and 360 +/- 71 m during apical pacing, p < 0.5 for both). Mitral and tricuspid regurgitation improved during para-Hisian pacing (1.22 +/- 0.8 and 1.46 +/- 0.5 index, respectively, vs. 1.68 +/- 0.6 [p < 0.05] and 1.62 +/- 0.7 [p = NS] index at baseline, respectively), with a slight worsening during apical pacing (1.93 +/- 1 and 1.93 +/- 0.7 index, respectively, p < 0.05 for both). CONCLUSIONS: Permanent para-Hisian pacing is feasible and safe. Compared with conventional right apical pacing, it allows an improvement in functional and hemodynamic parameters over long-term follow-up.

Aged↗

PubMed1993

Plasma big endothelin-1 concentrations in congestive heart failure patients with or without systemic hypertension.

Plasma endothelin concentrations were evaluated in 53 chronic, congestive heart failure (CHF) patients with or without history of systemic hypertension, as well as in 9 with hypertension only and in 22 healthy control subjects. Plasma renin, aldosterone and atrial natriuretic peptide, as well as clinical and hemodynamic data were determined. In patients with CHF, big endothelin-1 was, independent of hypertension history, significantly greater than in hypertensive patients with normal cardiac function and in control subjects (both p < 0.0001). Patients with severe CHF had significantly greater big endothelin-1 values than did those with moderate CHF. During 12-month follow-up, 11 patients with CHF underwent heart transplantation, and 9 died; these patients had significantly greater big endothelin-1 concentrations than did the 33 clinically stable patients (p < 0.001). Big endothelin-1 and atrial natriuretic peptide correlated with right atrial pressure, pulmonary capillary wedge pressure, left ventricular ejection fraction, effort capacity and severity of CHF (New York Heart Association functional class).

Adult↗

PubMedDate not supplied

Pulsed Doppler echocardiography in the assessment of tricuspid regurgitation.

Pulsed Doppler echocardiography is a noninvasive method with high sensitivity and specificity for the assessment of tricuspid regurgitation. In patients with tricuspid regurgitation, pansystolic unusual Doppler signals are detected in the right atrial cavity, which are interpreted as tricuspid regurgitant flow signals. They distributed in a spindle-shaped area from the tricuspid orifice toward the right atrial posterior wall in parallel with the interatrial septum. The orientation of the range where the regurgitant Doppler signals are detected in the right atrial cavity shows the direction of the regurgitant jet. However, such a result is determined mainly in patients with functional tricuspid regurgitation. In regard to patients with organic tricuspid lesion, different considerations may be necessary. Semiquantitative grading of the severity of regurgitation is possible, based on the distance covered by the regurgitant signals from the tricuspid orifice. Tricuspid regurgitation is demonstrated also by contrast echocardiography. The severity is graded based on the distance reached by regurgitant curvilinear contrast echoes from the tricuspid valve in the M-mode echocardiography. If the ultrasound beam is adequately directed through the tricuspid orifice, the grade estimated by the contrast echoes are well correlated with that by the Doppler. However, if the M-mode is performed without the guide by the two-dimensional image, it may miss the most adequate beam direction for the observation, resulting in underestimating severity. The influences of tricuspid regurgitation are generally seen in the flow pattern of the major veins. However, they are more sharply reflected by the flow condition in the right atrial cavity than by the flows patterns in the major veins.

Blood Flow Velocity↗

PubMed1998

Evaluation of Right Ventricular Function During CABG: Transesophageal Echocardiographic Assessment of Hepatic Venous Flow Versus Conventional Right Ventricular Performance Indices.

The vulnerability of right ventricle (RV) to ischemic insult during cardiac surgery is being increasingly recognized. This study aims to evaluate right ventricular function by measuring hepatic venous flow (HVF) patterns using intraoperative transesophageal echocardiography (TEE), and to compare HVF with other conventional two-dimensional echocardiographic and hemodynamic indices of RV performance. Patients undergoing coronary artery bypass grafting (CABG) were studied intraoperatively using a multiplane dual frequency 5/3.7-MHz phased array transducer, a pulmonary artery catheter, and an arterial catheter. Peak velocities and time velocity integrals of HVF pattern were studied. Peak systolic-diastolic ratio (S/D) of biphasic HVF and reverse flow ratio (% reverse flow/forward flow = % RF/FF) were also examined. Two-dimensional echocardiographic measurements included: (1) transverse plane long-axis (LA) and short-axis (SA) planimetered areas expressed as ratios; LA maximum major and minor-axis shortening fractions; (2) tricuspid annular plane systolic excursion (TAPSE) ratio. All data were obtained after induction of anesthesia (stage 1), after sternotomy (stage 2), aftercardiopulmonary bypass (CPB) (stage 3), and after sternal closure (stage 4). Pre-CPB all 35 patients had biphasic HVF by Doppler. In 31 patients peak S/D ratio was >1. After CPB, there was significant reduction in systolic forward flow (S wave), along with an increase in late systolic reverse flow (V wave) and an increase in % RF/FF. At this stage TAPSE ratio decreased (pre CPB 0.33 +/- 0.12 vs post CPB 0.30 +/- 0.11). There was simultaneous decrease in 2-D long-axis LA (pre CPB 0.52 +/- 0.11 vs post CPB 0.31 +/- 0.01) and max major axis LA (pre CPB 0.38 +/- 0.06 vs post CPB 0.31 +/- 0.11). Max major axis LA correlated significantly with changes in right atrial pressure (P < 0.05). Tricuspid annular motion diminished significantly at sternal closure. Hepatic systolic forward flow and TAPSE ratio can be an indirect measure of RV systolic functions in correlation with maximum major axis LA changes. Evaluation of HVF provides unique insight into right ventricular dynamics. It is an easy, safe, and sensitive method for assessing RV functions intraoperatively.

Journal Article↗

PubMed1997

Simultaneous evaluation of left- and right-sided heart pumping function during dynamic leg exercise in patients with mild chronic congestive heart failure, with special reference to afterload and plasma noradrenaline.

We simultaneously measured increases in mean pulmonary capillary wedge pressure (delta PCW), mean right atrial pressure (delta RA), and cardiac index (delta CI) in response to dynamic leg exercise in 81 patients with mild congestive heart failure to clarify the relationship between the left-sided and right-sided pumping function of the heart. The ratio of delta CI to delta PCW was used as an index of left-sided heart performance and the delta CI/delta RA as an index of right-sided heart performance. We also determined systemic vascular resistance, as an index of afterload on the left heart; pulmonary vascular resistance, as an index of afterload on the right heart; and the plasma level of noradrenaline before and during dynamic leg exercise. Patients with delta CI/delta PCW > 0.181/ min/m2 per mmHg were regarded as having a well functioning left heart, and the patients with delta CI/delta PCW < or = 0.181/min/m2 per mmHg as having a poorly functioning left heart. Patients with delta CI/delta RA > 0.3111/min/m2 per mmHg were regarded as having a well functioning right heart, and those with delta CI/delta RA < or = 0.311/l/min/m2 per mmHg as having a poorly functioning right heart. Patients were classified into three groups: well functioning left and right heart (normal group; n = 40), poorly functioning left and right heart (bilateral group; n = 34), and poorly functioning left heart and well functioning right heart (left-sided group; n = 7). The systemic vascular resistance index decreased during leg exercise in all patients. The decrease was smaller in the bilateral group and the left-sided group than in the normal group. The pulmonary vascular resistance index increased during exercise in the bilateral group but was unchanged in the normal group and the left-sided group. The plasma level of noradrenaline increased during exercise in all patients, but the increase was greater in the bilateral and left-sided groups than in the normal group. Pretreatment with phentolamine, an alpha-adrenoceptor antagonist, inhibited the increase in the pulmonary vascular resistance index and restored the decrease in the systemic vascular resistance index during exercise in the bilateral group. Our results showed that systemic vascular resistance, which represents afterload on the left heart, increased in the presence of impaired left-sided heart pumping function and pulmonary vascular resistance, which represents afterload on the right heart, increased in the presence of impaired right-sided heart pumping function. The inhibited decrease in systemic vascular resistance and the increase in pulmonary vascular resistance during exercise were associated with alpha-adrenoceptor-mediated vasoconstriction caused by the increase in the plasma level of noradrenaline.

Aged↗

PubMed1997

Successful radiofrequency catheter ablation of automatic atrial tachycardia with regression of the cardiomyopathy picture.

Ectopic atrial tachycardia (EAT) is often refractory to pharmacological suppression, and if uncontrolled, it can lead to cardiomyopathy. Although RF current catheter ablation therapy has been effective in eliminating the arrhythmia, there is limited information, particularly in adult patients with regard to the reversal of the tachycardia induced cardiomyopathy. Four adult patients, 20-56 years of age, and a 6-year-old boy, were referred with refractory EAT. Four patients had heart failure and three had depressed LV function by echocardiographic criteria. All patients underwent electrophysiological study, and RF ablation was successful in abolishing the arrhythmogenic foci. Of these, four were located in the right atrium and one in the left atrium, and were identified by recording of the earliest atrial activation. No complications occurred. Termination of the EAT resulted in symptomatic improvement. Serial echocardiographic assessment of LV function indicated a significant reversal of the cardiomyopathy picture with reduction in chamber size and recovery in systolic function; indices of diastolic dysfunction persisted in one patient. Chronic, uncontrolled EAT can cause tachycardia induced cardiomyopathy. The picture of the cardiomyopathy resolves after elimination of the focus. RF ablation is both effective and safe, and may be considered as early therapy, particularly in patients with incessant EAT and ventricular dysfunction.

Adult↗

PubMedDate not supplied

A case of severe Ebstein's anomaly with incompetent pulmonary valve.

A case of Ebstein's anomaly with functional pulmonary atresia diagnosed in utero is presented. The diagnosis was confirmed by postnatal echocardiographic, angiographic, and postmortem pathologic findings. On echocardiography the septal leaflet of the tricuspid valve was displaced towards the right ventricular apex. The tricuspid valve was moderately regurgitant and the arterial duct was patent. Continuous wave or color Doppler revealed serious reduction in forward flow from right ventricle through the pulmonary arteries; however, massive pulmonary regurgitation was observed. Pulmonary circulation was dependent on the ductal flow due to functional pulmonary atresia. Angiography revealed the massively enlarged right atrium, the absence of forward flow through the tricuspid valve, transfer of contrast material through the atrial septal defect to the left atrium, and the retrograde inflow of the pulmonary arteries from the aorta via the patent arterial duct. Ebstein's anomaly accompanied by functional pulmonary atresia is very rare. The fetal and neonatal presentation of this anomaly is associated with poor outcome.

Cardiac Catheterization↗

PubMed1995

[The hemodynamic status and right ventricular diastolic function of bronchial asthma patients].

Doppler echocardiographic study of ventricular diastolic function in 90 BA patients gave evidence for diastolic left and right ventricular dysfunction in patients with moderately and gravely running BA. The above disorders were noted by changes in the speed of transmitral and transtricuspid flows: early filling rate (E) slowing, atrial systole filling rate (A) acceleration, E/A decrease. The degree of right ventricular diastolic dysfunction depends on right ventricular hypertrophy and total pulmonary resistance. Left ventricular diastolic function is related to right ventricular after-load.

Adolescent↗

PubMed2006

[Cardiopulmonary exercise test in the evaluation of exercise capacity in patients with Ebstein anomaly and patent ostium secundum atrial septal defect aged over 30 years].

UNLABELLED: There are few data available on applying the cardiopulmonary exercise test for evaluation of cardiac exercise capacity in adult patients with congenital heart diseases. The aim of the study was to perform this test in adults with Ebstein anomaly and patients with patent ASD II (atrial septal defect) and determination of potential relationships between these parameters and echocardiographically assessed hemodynamic indices. MATERIAL AND METHODS: Twenty patients with Ebstein anomaly mean aged 40.3 +/- 12.3 years were studied. Control group consisted of 19 individuals at mean age of 39.9 years. Echocardiography was performed for the evaluation of severity of the disease. Additionally, 36 patients with ASD II were included, mean age 44.7 +/- 8.2 years. The control group consisted of 25 individuals at mean age of 45.6 years. Maximum exercise treadmill test was carried out and resting and exercise spirometry. RESULTS: Ebstein anomaly. Maximum oxygen uptake, minute ventilation, maximum heart rate and blood pressure at peak exercise were significantly lower in study patients than in control group. VE/VCO2 was increased. No differences were observed between groups with respect to spirometric parameters. Oxygen uptake decreased along with the severity of the disease. ASD II. Maximum oxygen uptake, minute ventilation, maximum heart rate and blood pressure at peak exercise and spirometric parameters were significantly lower in study patients than in control group. Significant negative correlations were shown for VO2 (maximum oxygen uptake) and Qp:Qs (pulmonary to systemic flow ratio) (p = 0.004), maximum heart rate - HRmax and HRmax% and RV (end-diastolic right ventricular diameter) (p = 0.02 i p = 0.01), RV and systolic pressure at peak exercise (p = 0.03), obstruction marker FEV1 and RV (p = 0.04) and between RVSP (right ventricular end-systolic pressure) (p = 0.01). Negative correlation was observed between RQ (respiratory quotient) and RVSP (p = 0.004), and positive correlation between HRmax and VO2 (p = 0.005). CONCLUSIONS: The exercise capacity of adults with Ebstein anomaly and those with patent ASD II is significantly reduced. It decreases along with the echocardiographic severity of the disease in Ebstein anomaly patients and it seems to result from the right ventricular volume overload in patients with patent ASD II.

Abnormalities, Multiple↗

PubMed1999

Sevoflurane has no effect on sinoatrial node function or on normal atrioventricular and accessory pathway conduction in Wolff-Parkinson-White syndrome during alfentanil/midazolam anesthesia.

BACKGROUND: The effects of sevoflurane on the electrophysiologic properties of the human heart are unknown. This study evaluated the effects of sevoflurane on the electrophysiologic properties of the normal atrioventricular conduction system, and on the accessory pathways in patients with Wolff-Parkinson-White syndrome, to determine its suitability as an anesthetic agent for patients undergoing ablative procedures. METHODS: Fifteen patients with Wolff-Parkinson-White syndrome undergoing elective radiofrequency catheter ablation were studied. Anesthesia was induced with alfentanil (20-50 microg/kg) and midazolam (0.15 mg/kg), and vecuronium (20 mg) and maintained with alfentanil (0.5 to 2 microg x kg(-1) x min(-1)) and midazolam (1 or 2 mg every 10-15 min, as required). An electrophysiologic study measured the effective refractory period of the right atrium, atrioventricular node, and accessory pathway; the shortest conducted cycle length of the atrioventricular node and accessory pathway during atrial pacing; the effective refractory period of the right ventricle and accessory pathway; and the shortest retrograde conducted cycle length of the accessory pathway during ventricular pacing. Parameters of sinoatrial node function included sinus node recovery time, corrected sinus node recovery time, and sinoatrial conduction time. Intraatrial conduction time and the atrial-His interval were also measured. Characteristics of induced reciprocating tachycardia, including cycle length, atrial-His, His-ventricular, and ventriculoatrial intervals, also were measured. Sevoflurane was administered to achieve an end-tidal concentration of 2% (1 minimum alveolar concentration), and the study measurements were repeated. RESULTS: Sevoflurane had no effect on the electrophysiologic parameters of conduction in the normal atrioventricular conduction system or accessory pathway, or during reciprocating tachycardia. However, sevoflurane caused a statistically significant reduction in the sinoatrial conduction time and atrial-His interval but these changes were not clinically important. All accessory pathways were successfully identified and ablated. CONCLUSIONS: Sevoflurane had no effect on the electrophysiologic nature of the normal atrioventricular or accessory pathway and no clinically important effect on sinoatrial node activity. It is therefore a suitable anesthetic agent for patients undergoing ablative procedures.

Adult↗