CARDIAC-FUNCTION IN PATIENTS WITH TREATED HYPERTENSION DURING AORTIC-ANEURYSM REPAIR

Objectives: To investigate the impact of arterial hypertension on card iac function during aortic cross-clamping and declamping. Design: Pros pective study. Setting: University hospital. Participants:Twenty treat ed hypertensive males with slight left ventricular hypertrophy and 10 normotensive controls undergoing elective repair of an abdominal aorti c aneurysm. Interventions: Using transesophageal echocardiography, the mitral inflow profile was evaluated during aortic cross-clamping and declamping. Measurements and Main Results: During the clamping period, the ratio of peak atrial to peak early filling velocity (PA/PE) was s ignificantly higher in the hypertensive patients. One minute after aor tic cross-clamping, mean arterial pressure (MAP) and pulmonary artery occlusion pressure significantly increased in the hypertensive patient s, whereas they did not change in the normotensive group. Cardiac inde x and heart rate significantly decreased after crossclamping, and incr eased after clamp release in both groups. PA/PE significantly dropped in both groups after aortic declamping, and returned to baseline value s thereafter. MAP also decreased significantly in both groups after cl amp release, but the fall of MAP tended to be more pronounced in the h ypertensive patients. Conclusions: In the treated hypertensive patient s, more pronounced hemodynamic and echocardiographic responses to aort ic cross-clamping probably mirror the altered diastolic left ventricul ar function in these patients. With respect to intraoperative manageme nt, however, the treated hypertensive patients did not react grossly d ifferently from the normotensive controls. Copyright (C) 1998 by W.B. Saunders Company.