S. Aakhus et al., INCREASED LEFT-VENTRICULAR CONTRACTILITY DURING CROSS-CLAMPING OF THEDESCENDING THORACIC AORTA, Journal of cardiothoracic and vascular anesthesia, 9(5), 1995, pp. 497-502
Citations number
29
Categorie Soggetti
Anesthesiology,"Peripheal Vascular Diseas","Cardiac & Cardiovascular System
Objective: To evaluate how left ventricular (LV) dimensions and contra
ctility and proximal systemic hemodynamics respond during and after 30
minutes of cross-clamping of the descending thoracic aorta. Design: T
he study was prospective and controlled. Setting: The study was perfor
med in a university animal laboratory. Participants: Ten pigs (bodywei
ght: 22 to 30 kg). Interventions: The pigs were anesthetized with fent
anyl and ketamine, and the heart and aorta were exposed through a left
thoracotomy. The aortic root pressure and flow and LV dimensions were
monitored with a high-fidelity pressure catheter, a precalibrated ult
rasonic transit-time flow probe, and by two-dimensional ultrasound ima
ging, respectively. Measurements and Main Results: After 1 minute of c
ross-clamping, LV end-diastolic and end-systolic diameters were increa
sed 17% and 32% above baseline (both p < 0.001), respectively, whereas
LV fiber shortening was decreased by 35% (p < 0.05) corresponding to
the 257% increase in wall stress (p < 0.001). After 5 minutes, LV dime
nsions, fiber shortening, and wall stress had returned to baseline lev
els. After 10 minutes, fiber shortening was increased 67% (p < 0.05),
although wall stress was maintained at baseline levels. Simultaneously
, the aortic mean blood pressure, heart rate, and cardiac output peake
d 112% (p < 0.001), 81% (p < 0.001), and 125% (p < 0.01) above baselin
e, respectively. Conclusions: Cross-clamping grossly increased systemi
c afterload grossly and was followed by moderate LV dilation, which re
solved after 5 minutes owing to the combined effects of proximal vasod
ilation. increased myocardial con; tractility. and tachycardia. This h
yperdynamic circulatory state was maintained during cross-clamping and
decreased after declamping. (C) 1995 by W.B. Saunders Company