Perioperative alterations in plasma endothelin-1 and echocardiographic correlates of right heart function

Objective: To determine whether greater changes in plasma endothelin-1 (ET- 1) concentrations and right ventricular systolic pressure occur after major thoracic surgery than after major abdominal operations. Design: Prospective study. Setting: University hospital. Participants: Patients undergoing elective thoracotomies (n = 12) or laparo tomies(n = 10). Interventions: ET-1 was measured from blood obtained before anesthesia and again on postoperative days 1, 2, 3, and 5 (or 6). Transthoracic echocardio graphy was performed before surgery and on postoperative day 2 to evaluate right-sided heart function. Measurements and Main Results: After abdominal and thoracic surgery, system ic and estimated pulmonary vascular pressures were normal in both groups an d unaffected by surgery. Plasma ET-1 concentrations decreased from baseline values during the first postoperative week with no differences between the groups. Conclusions: In patients without organic heart disease, plasma ET-1 levels do not increase in response to major abdominal or thoracic surgery. Whether or not plasma ET-1 concentrations are elevated in patients developing clin ically significant postoperative pulmonary hypertension requires further st udy. Copyright (C) 2000 by W.B. Saunders Company.