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PubMed1989

Time course and hemodynamic effects of alpha-1-adrenergic bolus administration in anesthetized patients with myocardial disease.

Phenylephrine (Phe) is frequently administered as an intravenous (IV) bolus to increase blood pressure, yet the acute time course and hemodynamic effects of bolus Phe in patients with myocardial disease have not been reported. Therefore 50 randomized IV bolus doses of Phe (50, 100, 150, or 200 micrograms) were given to 18 patients during anesthesia for elective coronary artery surgery. Esophageal Doppler techniques were used to continuously monitor cardiac output (CO); mean arterial pressure (MAP), CO, and calculated systemic vascular resistance (SVR) were recorded every 5 seconds for a total of 2 minutes. The hemodynamic changes (mean +/- SEM) for each of the four doses of Phe (50, 100, 150, 200 micrograms) were maximal at about 42 seconds after the drug was given. They consisted of an increase in MAP (11.6 +/- 2.1, 15.6 +/- 2.4, 14.7 +/- 2.4, 18.0 +/- 1.5 mm Hg); increase in SVR (766 +/- 190, 930 +/- 310, 950 +/- 344, 1732 +/- 824 dynes.sec.cm-5); and a decrease in CO (-.58 +/- .11, -.68 +/- .13, -.73 +/- .20, -.77 +/- .18 L.min-1). Hypertension, increased age, low preoperative ejection fraction, high baseline CO, and low baseline SVR significantly (P less than 0.05) decreased hemodynamic responses to Phe (see text). In conclusion, bolus IV Phe in patients with myocardial disease increases MAP and SVR and simultaneously decreases CO; these peak hemodynamic events occur approximately 42 seconds after Phe administration.

Aged↗
PubMed1989

[The effect of bunazosin vs captopril on hemodynamic and neurohumoral parameters in patients with congestive heart failure].

The hemodynamic parameters (right atrial pressure, mean pulmonary artery pressure, pulmonary capillary wedge pressure, cardiac index, heart rate, blood pressure) and neurohumoral responses (alpha-ANP, plasma renin activity, aldosterone, angiotensin II) of Captopril, oral ACE inhibitor, and Bunazosin, oral alpha 1-blocker, were investigated in 28 patients with congestive heart failure at rest and after exercise. These data were analysed in both acute and chronic phases. 1) Acute effect. Captopril produced significant improvement of neurohumoral factors at rest and also after exercise. Bunazosin reduced alpha-ANP, but other neurohumoral factors did not change. Bunazosin produced significant hemodynamic improvement both at rest and after exercise. 2) Chronic effect. Captopril produced significant hemodynamic improvement both at rest and after exercise. Improvement of neurohumoral factors in acute phase was also preserved at chronic phase. On Bunazosin, improvement of hemodynamics at acute phase was also preserved at chronic phase without deterioration of neurohumoral factors.

Adrenergic alpha-Antagonists↗
PubMed1989

[Changes in humoral substances in induced cirrhosis and their effects on portal hemodynamics].

The change of humoral substances in the blood of cirrhotic rat was studied at different stages of development, together with their effects on the portal hemodynamics. The profiles of humoral substances and hemodynamics in two different cirrhotic rat models, as well as the changes of portal hemodynamics in the normal rats after perfusion with the arterial blood from cirrhotic rats were also investigated. It was found that: during the development of cirrhosis, glucagon increased markedly at all stages, histamine and vasoactive intestinal polypeptide (VIP) increased at early stage only, while serotonin (5-HT) and somatostatin(SS) increased at middle and advanced stages. In the CCl4 induced cirrhosis, glucagon was the main humoral substance, whereas in the thioacetamide (TAA) induced cirrhosis, histamine and 5-HT were mainly elevated. The portal hemodynamics altered differently in different stages during the development of cirrhosis and in the two different cirrhotic rat models. The perfusion with the arterial blood from cirrhotic rats caused an increase of portal venous pressure and portal venous flow in normal rats.

Animals↗
PubMed1989

[Intraoperative hemodynamics of pyrolytic carbon cambered bileaflet valve replacement in animals].

Pyrolytic carbon cambered bileaflet valve developed by Chengdu University of Technology and Sciences was evaluated for its hemodynamics. The curved surface of the valve leaflet is cylindrical. Under anaesthesia, cardiopulmonary bypass and chemical cardioplegia, a cambered bileaflet valve (i.d. = 16 mm) was replaced at mitral position in each of 12 goats. Before valve replacement, mitral flow rate (MFR) was 74.9 +/- 12.3 ml.sec-1, average valvular pressure drop delta P) 0.56 +/- 0.17 kPa (4.2 +/- 1.3 mmHg) and effective opening area (EOA) of the valve 1.20 +/- 0.18 cm2. After valve replacement, corresponding hemodynamic parameters were 49.3 +/- 12.7 ml.sec-1, 0.46 +/- 0.17 kPa (3.8 +/- 1.3 mmHg) and 0.81 +/- 0.12 cm2 respectively. In our previous report on yak pericardiac heart valve (i.d. = 20 mm) in goats, corresponding hemodynamic parameters after valve replacement were 45.6 +/- 11.8 ml.sec-1, 0.86 +/- 0.32 kpa (6.4 +/- 2.4 mmHg) and 0.65 +/- 0.26 cm2. With comparable mitral flow rate and heart rate (113.6 +/- 19.6 min-1 vs 119.1 +/- 17.1 min-1), the average valvular pressure drop of pyrolytic carbon cambered bileaflet valve is significantly smaller than that of the yak pericardiac valve (P less than 0.001), and the effective opening area is marginally larger than that of the yak pericardiac valve (0.05 less than P less than 0.1). If the same-sized valves of this two kinds are used, the hemodynamic parameter of cambered bileaflet valve would be better than those of yak pericardiac valve. Since the latter valve has been successfully used in patients, the present valve might be applicable in clinical situation.

Animals↗
PubMed1989

[Hemodynamics and gas exchange in acute lung embolism].

The main hemodynamic consequence of pulmonary embolism is the acute mechanical reduction of the pulmonary vascular cross-sectional area. This results in a sudden increase of the pulmonary vascular resistance, and if the cardiac output is to be maintained, in an increase in pulmonary artery pressure and right ventricular work. The extent of hemodynamic changes in pulmonary embolism are determined primarily by the size of the emboli and whether or not the patient has underlying cardiopulmonary disease. Although humoral factors and neural reflexes play a role in determining the severity of hemodynamic responses to pulmonary embolism in experimental animals, their role in patients is uncertain. In patients free of preembolic cardiopulmonary disease, the extent of embolic obstruction can be related directly to the mean pulmonary artery pressure. Accordingly, either the extent of obstruction or the mean pulmonary artery pressure may be used as a measure of right ventricular afterload. Obstruction of 25 to 40% leads to an increase in mean pulmonary artery pressure of 20 to 30 mm Hg, massive obstruction over 75% to a pressure of 40 to 45 mm Hg. Continuous hemodynamic monitoring helps to estimate the speed of the resolution of emboli and to a certain extent the adequacy of treatment. Right arterial pressure is consistently elevated by a mean pulmonary artery pressure over 30 mm Hg and provides also a rough estimate of the degree of pulmonary vascular obstruction. A previously normal right ventricle will dilate at a mean pulmonary artery pressure of 40 to 45 mm Hg. which may result in acute tricuspid insufficiency.(ABSTRACT TRUNCATED AT 250 WORDS)

Heart Atria↗
PubMedDate not supplied

[Pathogenesis of intra-operative disruption of hemodynamics during hemodialysis of patients poisoned by phosphorganic insecticides, complicated by the development of exotoxic shock].

The results of central hemodynamic and myocardial contractility studies during hemodialysis in 62 patients with severe fluoroorganic insecticide poisoning complicated by exotoxic shock are reviewed. It has been established that hemodynamic disturbances are manifested in progressing fall of venous pressure, stroke volume and cardiac output accompanied by the onset of phase myocardial hypodynamia syndrome. The leading role of hypovolemia resulting from ultrafiltration in the pathogenesis of the above hemodynamic disturbances has been revealed. The results obtained make it possible to outline approaches aimed at correction of intraoperative hemodynamic disturbances and to increase safety of extracorporeal hemodialysis.

Adolescent↗
PubMed1989

[Cardiovascular and pulmonary changes in patients with an isolated cerebral lesion. I. Hemodynamics].

This study included 44 patients with a severe isolated cerebral lesion (decerebrate posturing on admission) with the purpose of examining the hemodynamic changes caused by cerebral trauma to see whether these changes might give additional information as to the prognosis of these patients. Patients with a previous myocardial infarction, pulmonary edema or embolism, chronic obstructive or restrictive pulmonary disease, proven or suspected aspiration, and polytrauma patients with an accompanying cerebral lesion were excluded. The study started on the day of admission to the intensive care unit and lasted for up to 6 days maximally. Both on admission and throughout the observation period, survivors (S) showed a higher neurological status score on the Innsbruck Coma Scale than non-survivors (NS). The hemodynamic profile was characterized by a hyperdynamic reaction with an increase in cardiac index and systemic arterial pressure. The hyperdynamic state was much more pronounced in S than in NS, who tended to show a normo-or even hypodynamic state. On admission to the intensive care unit 13 of 31 NS (41.9%) had a cardiac index less than 3.01/min.m2 as compared to only 1 of the 13 S (7.7%). With regard to pulmonary artery pressure, there was no difference between S and NS, while the pulmonary vascular resistance was significantly higher in NS than in S. In addition, S showed a kind of circadian rhythm of systemic arterial pressure, that was absent in NS. Rather than one single hemodynamic parameter being of prognostic relevance it is the complex parameter "left-ventricular work index" (LVWI) includes all the relevant parameters of left-ventricular mechanical work. Throughout the observation period, this parameter was consistently higher in S than in NS, although the left ventricular filling pressure (represented by the diastolic pulmonary artery pressure) was equal in both groups. While an inverse relationship between age and LVWI could be shown in S, this could not be demonstrated for NS, indicating that the differences in hemodynamic patterns between S and NS should be due to other reasons, such as the degree of the cerebral lesion affecting the trauma-adaptive regulation of the cardiovascular reaction to a severe isolated cerebral lesion.

Adolescent↗
PubMed1989

[Central hemodynamics and oxygen supply in patients with ischemic heart disease associated with chronic bronchitis].

A comparative study of central hemodynamics and systemic oxygen supply was carried out with reference to hemodynamic type in patients with uncomplicated coronary heart disease (CHD) and CHD combined with chronic nonobstructive bronchitis. Patients with combined pathology and hyper- or hypokinetic circulation type showed the same hemodynamic pattern at rest and oxygen supply during exercise, as did coronary patients with similar circulation types, that suggested latent heart failure and were more marked in patients with hypokinetic circulation. In coronary patients with chronic bronchitis and eukinetic circulation, central hemodynamics and oxygen supply were impaired, as compared to coronary patients with similar circulation types.

Adult↗
PubMed1989

[A study on hemodynamics in the brain death in dogs, with particular reference to left ventricular pressure-volume relationship].

The hemodynamics of the brain death state still remains unknown in many respects. With special reference to the left ventricular pressure-volume relationship, hemodynamics was analyzed in 26 dogs which were subjected to complete cerebral destruction and catecholamine administration to prevent marked hypotension caused by brain death. The catecholamine used was dopamine (5-15 gamma; DA group), dobutamine (5-15 gamma; DOB group), noradrenaline (0.5-1.5 gamma; NAD group) and adrenaline (0.5-1.5 gamma, AD group). Left ventricular volume was calculated according to the approximate formula by Suga et al., using a pair of sonomicromanometers installed at the maximum internal transverse diameter. The indices determined were end systolic elastance (Ees), effective arterial elastance (Ea), ejection fraction (EF), mean Vcf, peak dP/dT and other hemodynamic parameters routinely used. The results were as follows: 1) the effect of catecholamine on Ees prior to brain death was DA = DOB greater than NAD = AD. 2) Peak dP/dT after brain death was significantly reduced to 56-73% of the pre-brain-death value. 3) Ees after brain death was significantly reduced to 56-73% of the pre-brain-death value (except for NAD 1.0 & 1.5 gamma: not significantly reduced), whereas Ea was significantly reduced to 43-70% (except for AD group: unchanged). As a result, Ea/Ees was reduced in both DA group (10 & 15 gamma) and NAD group (1.0 & 1.5 gamma) compared with their pre-brain-death values. 4) EF in DA and NAD groups was higher than the pre-brain-death value, showing a tendency dissociating from Ees. 5) EF was found to be mainly dependent on Ea/Ees according to the formula by Sunagawa et al. 6) AD was the only catecholamine which neither decreased peripheral vascular resistance nor changed Ea. It was concluded in the author's study using the above brain death model that 1) responses of catecholamine to the peripheral vascular system were of lesser grade than those to the heart, and 2) Ea/Ees (ventriculo-arterial coupling) should be extremely useful in evaluating left ventricular performance on the basis of the cardio-vascular hemodynamic relationship, and was strongly suggested to be a reliable index of left ventricular performance in brain death.

Animals↗
PubMedDate not supplied

Comparative effects of the antidepressants amitriptyline, mianserin and adinazolam on hemodynamics and ECG in myocardial infarcted dogs.

This study was undertaken to examine the effects of mianserin (MIA), a tetracyclic antidepressant, and adinazolam (ADI), a new benzodiazepine antidepressant on cardiac function and electrocardiogram in normal and infarcted hearts of anesthetized dogs, and to compare the effects with those of amitriptyline, a commonly used tricyclic antidepressant. The parameters measured were: heart rate (HR); mean arterial blood pressure (MP); aortic flow (AF); maximal rate of increase of left ventricular pressure (LV dp/dt); blood flow of left circumflex of left coronary artery (CAF) and PQ and QRS intervals. The double product (DP) was calculated from HR and the arterial pressure. AMI increased HR, DP, LV dp/dt and CAF in the normal group, while in the infarcted group, AMI increased HR, DP and CAF, but decreased LV dp/dt at 3 mg/kg. AMI at 2 and 3 mg/kg prolonged QRS intervals in the infarcted groups. MIA increased HR and DP in the normal group at doses of 1 mg/kg or more, while in the infarcted group it produced only slight effects in hemodynamic parameters and PQ and QRS intervals. ADI had little effect on hemodynamics and PQ and QRS intervals in the normal group. However, it decreased LV dp/dt, CAF, MP at 3 mg/kg in the infarcted group. In conclusion, AMI markedly influenced cardiac hemodynamics and QRS interval in the myocardial infarcted group, while, on the other hand, MIA and ADI, in clinical doses, had only a slight effect on hemodynamics and PQ and QRS intervals in the infarcted group. Thus MIA and ADI were safer than AMI in the animals with myocardial infarction.

Amitriptyline↗
PubMed1989

Effects of hypothermia and hemodilution on oxygen metabolism and hemodynamics in patients recovering from coronary artery bypass operations.

The coexistence of hypothermia and hemodilution in patients in the intensive care unit immediately postoperatively after coronary artery bypass graft operations presents concerns regarding the adequacy of hemodynamics and oxygen metabolism. We evaluated the hemodynamic status and oxygen metabolism during the postoperative recovery period in six patients with moderate hemodilution (hematocrit value 34% +/- 3%) and in eight patients with marked hemodilution (hematocrit value 23% +/- 2%). All patients were well sedated and paralyzed with pancuronium bromide during the study period, during which their body temperature was slowly returning toward normal. In both groups, cardiac index at 34 degrees C was about 40% lower than at 37 degrees C. This was associated with 50% higher systemic vascular resistance and 30% lower oxygen availability to tissue. Oxygen consumption, however, was proportionally lower (45%) and coronary perfusion pressure was higher (28%) at 34 degrees C than at 37 degrees C; thus neither mixed venous nor coronary sinus blood oxygen saturation was compromised under hypothermic conditions. Although the trends in hemodynamic changes were similar in both groups, cardiac indices in patients with marked hemodilution were higher than cardiac indices in those with moderate hemodilution at all temperatures. This observation indicates that the hemodilution-induced rise in cardiac index remains intact even under hypothermic conditions. Under the conditions we studied, hypothermia with or without hemodilution had no significant adverse effects on hemodynamics and oxygen metabolisms of the whole body or of the heart.

Aged↗
PubMed1989

Hemodynamic characteristics of the Jarvik-7 total artificial heart.

To identify the optimal means of artificial circulation, driving controls and resultant hemodynamics were correlated with clinical outcomes in 37 Jarvik-7 recipients up to 72 hours after implantation. When patients with subsequent transplantation (n = 16) were compared with those who died on the Jarvik-7 heart (n = 21), there were no significant differences in total artificial heart driving mode such as frequency, ventricular driving pressures, systolic-diastolic ratio, or vacuum use, nor were there any differences in the hemodynamics achieved, such as device output (cardiac output) or atrial filling pressures, throughout the observation. However, improvements of other organ functions, especially kidney and liver, were remarkable in that transplant patients immediately experienced increased urine output and reversal of secondary organ dysfunction. The nontransplant group failed to diurese and continued to deteriorate despite similar hemodynamics. When a smaller model of the Jarvik-7 (volume of 70 ml, n = 18) was compared with the standard model (volume of 100 ml, n = 19), again there were no significant differences except that ventricular stroke volume was consistently less for the 70-ml model. Because of a slightly higher heart rate in the smaller model, device output did not differ between recipients of the two types. The results suggest that once successfully implanted, the Jarvik-7 provides adequate perfusion without associated mortality from circulatory failure, regardless of the size of the ventricle. Recovery from other organ failure appears to be independent of postimplant hemodynamics, a phenomenon that suggests the importance of preimplant status and patient selection.

Adult↗
PubMed1985

Hemodynamic effects of high doses of corticosteroids.

It is somewhat difficult to reconcile the contrasting findings regarding the hemodynamic actions of high doses of corticosteroids in shock. The studies differ according to type of shock (hypovolemic, septic or cardiogenic), animal species, shock model, type of corticosteroid, etc. Beneficial hemodynamic effects (e.g. myocardial improvement, vasodilation) of steroids given alone are not consistently observed and when so often mild and transient. This might indicate that the hemodynamic changes of corticosteroids are not due to primary actions on the cardiovascular system but rather represent the hemodynamic consequences of the metabolic response to corticosteroid therapy. If, however, the corticosteroid therapy is combined with an alpha-adrenoreceptor blocker the nutritive tissue blood flow is distinctly increased.

Adrenal Cortex Hormones↗
PubMed1988

Rapid administration of a narcotic and neuromuscular blocker: a hemodynamic comparison of fentanyl, sufentanil, pancuronium, and vecuronium.

High-dose narcotic anesthetic inductions usually avoid circulatory depression better than do other techniques; however, the selection of a narcotic and neuromuscular blocker influences subsequent hemodynamic responses. One hundred-one patients having aortocoronary bypass graft (CABG) surgery were investigated using four combinations of a narcotic and neuromuscular blocker: group FP (fentanyl 50 micrograms/kg, pancuronium 100 micrograms/kg); group FV (fentanyl 50 micrograms/kg, vecuronium 80 micrograms/kg); group SP (sufentanil 10 micrograms/kg, pancuronium 100 micrograms/kg); and group SV (sufentanil 10 micrograms/kg, vecuronium 80 micrograms/kg), each combination being administered over 2 minutes. Hemodynamic functions were then monitored for 10 minutes before tracheal intubation. Significant changes included increases in heart rate in the groups receiving pancuronium and decreases in those receiving vecuronium. In all groups mean arterial pressure initially decreased; systemic vascular resistance index decreased significantly in all groups except SV. Cardiac index decreased significantly only in group SV. Circulatory depression requiring treatment with vasopressor or anticholinergic drugs was more common in patients given vecuronium. Cardiac arrhythmia occurred most often in group SP; only in group FP were there no arrhythmias, ischemic changes, or hemodynamic disturbances requiring intervention. Time to onset of neuromuscular blockade did not differ among the four groups, but transient chest wall rigidity occurred significantly more often with sufentanil than with fentanyl. Overall, the fentanyl/pancuronium combination afforded the greatest hemodynamic stability, whereas the sufentanil/vecuronium combination proved least satisfactory because of bradycardia and hypotension, requiring treatment in 35% of group SV patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Analgesics, Opioid↗
PubMed1988

Anesthetic and hemodynamic effects of the stereoisomers of medetomidine, an alpha 2-adrenergic agonist, in halothane-anesthetized dogs.

The anesthetic-sparing and hemodynamic effects of the stereoisomers of the highly selective alpha 2-adrenergic agonist medetomidine were studied in halothane-anesthetized dogs. Male beagles were anesthetized with halothane in oxygen. After a 2-hour equilibration period, halothane MAC and baseline hemodynamic functions were determined. DL-(n = 7), D- (n = 5), or L-medetomidine (n = 5) at 1, 3, and 10 micrograms/kg was administered via a right atrial port over 15 minutes while each dog was given halothane at the MAC dose for that animal. Twenty minutes after the end of infusion (when the hemodynamic variables were stable), hemodynamic function was reassessed. Halothane MAC was then redetermined. MAC for halothane significantly decreased after DL-medetomidine administration in a dose-dependent fashion to the extent that at the highest dose (10 micrograms/kg) the halothane MAC was less than 0.1%. This effect could be mimicked by the D-isomer, whereas the L-isomer was without effect. Neither isomer changed the mean arterial pressure, whereas only the D-isomer significantly decreased heart rate and cardiac output. Medetomidine, the highly selective alpha 2-adrenergic agonist, reduces the MAC for volatile anesthesia by a greater degree than with any other physiologic, pharmacologic, or pathologic intervention thus far reported. The fact that this effect is stereospecific suggests a structure activity relation that can be accounted for by a homogeneous receptor population. The role of medetomidine as a supplemental anesthetic agent appears promising and requires further investigation.

Adrenergic alpha-Agonists↗
PubMed1989

Thromboxane mediation of pulmonary hemodynamic responses after neutralization of heparin by protamine in pigs.

Protamine neutralization of heparin is often associated with severe hemodynamic side-effects, including pulmonary hypertension and systemic hypotension. Because prostanoids may be involved, the authors studied the role of arachidonic acid metabolites, especially thromboxane A2, in this process. During anesthesia with enflurane and fentanyl, four groups of pigs were studied: Group 1 (n = 10) received heparin (250 IU/kg), followed by protamine (100 mg) after 15 minutes to neutralize the heparin. The same protocol was used in group 2 (n = 11), except that the thromboxane A2 receptor antagonist BM 13.177 (10 mg/kg) was infused 5 minutes before the protamine. The protocol for group 1 was also used for group 3 (n = 7) except that these animals were pretreated with indomethacin (10 mg/kg). Animals in group 4 (n = 10) were given protamine only (100 mg). Pulmonary artery pressure and pulmonary vascular resistance increased significantly in group 1 after protamine neutralization of heparin. This was accompanied by significant increases in plasma concentrations of the cyclooxygenase products thromboxane B2, 6-keto-prostaglandin F1 alpha, and prostaglandin F2 alpha. Cyclooxygenase products increased to comparable degrees in group 2, but without hemodynamic effects. Leukocyte counts decreased comparably in both groups. Hemodynamic reactions, as well as changes in plasma prostanoid levels were absent in group 3, and group 4, but leukocyte counts were less affected in animals that received protamine alone. The results indicate that the hemodynamic side-effects of protamine are mediated by prostanoids and that thromboxane A2 release is the pivotal step, because side effects were effectively prevented by pretreatment with a thromboxane receptor antagonist.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1985

Long-term hemodynamic evaluation of lower extremity percutaneous transluminal angioplasty.

Percutaneous transluminal angioplasty (PTA) has provided an alternative method of treatment for occlusive disease of the lower extremities. However, the long-term durability of PTA compared with that of surgical reconstruction has not been adequately evaluated. This study was undertaken to assess the long-term hemodynamic results of PTA. Thirty-four dilatations performed on 28 patients over a 30-month period and followed for 1 to 53 months were reviewed. Twenty-two dilatations were done in the iliac arteries, seven in the superficial femoral, three in the popliteal, one in the peroneal artery, and one at a bypass graft anastomosis. All patients underwent noninvasive measurements of lower extremity segmental pressure prior to dilatation and at scheduled follow-up intervals. Success was defined as an increase in the Doppler-derived segmental lower extremity/brachial index of greater than or equal to 0.15 or normalization of the index (greater than or equal to 0.90), measured at the closest level distal to the site of dilatation. Sixteen of 22 iliac dilatations (72.7%) were initially successful. However, long-term success was maintained in only six (27.6%). Cumulative hemodynamic success for the initially successful iliac dilatations was 28% at 3 years. Seven of 11 (63.6%) dilatations performed on infrainguinal arteries were initially successful; however, only two (18.2%) experienced continued success. Cumulative hemodynamic success for the initially successful infrainguinal dilatations in this group was 35% at 3 years. Although immediate patency and improvement in hemodynamic parameters are similar to comparable surgical procedures, these results demonstrate that PTA is not as durable as conventional surgical procedures.

Adult↗
PubMed1988

Renal hemodynamic effects of a short-term high protein and low protein diet in patients with renal disease.

The renal hemodynamic effects of short-term protein loading and short term protein restriction were studied in patients with renal disease. Eleven patients adhered to a high protein diet (1.8 g/kg/day) and, subsequently, to a low protein diet (0.6 g/kg/day) for four weeks each. Renal hemodynamics were studied at the end of the respective dietary periods. Glomerular filtration rate (inulin clearance) did not change significantly (delta %: -1.5 +/- 5.4%; mean +/- s.e.m.), whereas endogenous creatinine clearance was lower on the low protein diet (delta %: -7.8 +/- 2.8%; p less than 0.02), suggesting an interference with the tubular secretion of creatinine. Effective renal plasma flow was significantly lower on the low protein diet (223.7 +/- 47.6 ml/min vs 282.1 +/- 67.1 ml/min; delta %: -15.4 +/- 4.9%; p less than 0.02). As a result, filtration fraction increased from 0.18 +/- 0.01 on the high protein diet to 0.22 +/- 0.02 on the low protein diet (p less than 0.01). The low protein diet caused a significant decrease in protein excretion from 4.0 +/- 0.9 g/24 h to 3.1 +/- 0.7 g/24 h (p less than 0.02). Our study demonstrates that renal hemodynamic responses to more sustained protein loading and protein restriction differ from the reported responses to acute protein loading. Different mechanisms may be involved. In this light it is doubtful if the renal hemodynamic response to acute protein loading can predict a beneficial effect of protein restriction.

Adult↗