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Cardiac dysfunction during abdominal aortic operation: the limitations of pulmonary wedge pressures.

Abstract：

:The mortality rate for elective abdominal aortic operations remains between 3% and 8% despite careful hemodynamic monitoring, and half of these deaths are cardiac in origin. An extensive evaluation of ventricular function was performed during abdominal aortic operation to detect subtle abnormalities in systolic or diastolic ventricular function that could precipitate progressive ischemic cardiac injury. Twenty-three patients undergoing elective abdominal aortic operations (14 patients with abdominal aortic aneurysm [AAA] and nine patients with aortoiliac occlusive disease [AIOD] ) had hemodynamic and nuclear ventriculographic measurements performed preoperatively, during aortic clamping, and immediately after aortic declamping. No differences were found in the hemodynamic response to operation between patients with AAA or AIOD. Volume loading was performed at each time period to assess ventricular function. Myocardial performance (the relation between cardiac index and end-diastolic volume index) and systolic function (the relation between systolic blood pressure and end-systolic volume index) were depressed during aortic clamping (p less than 0.05), suggesting decreased contractility, but returned to baseline values after declamping. Diastolic compliance (the relation between pulmonary capillary wedge pressure and end-diastolic volume index) decreased after declamping (p less than 0.05), suggesting early myocardial ischemia. The decrease in diastolic compliance rendered pulmonary capillary wedge pressure a poor index of left ventricular preload after declamping. Higher pressures were required to maintain adequate diastolic volumes. Despite careful hemodynamic monitoring, potentially ischemic ventricular dysfunction was found during abdominal aortic operation.

journal_name

J Vasc Surg

journal_title

Journal of vascular surgery

authors

Kalman PG,Wellwood MR,Weisel RD,Morley-Forster PK,Teasdale SJ,Ivanov J,Johnston KW,McLaughlin PR,Baird RJ,Cain JP

subject

Has Abstract,Author List Incomplete

pub_date

1986-05-01 00:00:00

pages

773-81

issue

eissn

0741-5214

issn

1097-6809

pii

S074152148600143X

journal_volume

pub_type

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Cardiac dysfunction during abdominal aortic operation: the limitations of pulmonary wedge pressures.