Improved cardiac function in patients with obstructive jaundice after internal biliary drainage: Hemodynamic and hormonal assessment

Objective To investigate myocardial function in patients with obstructive j aundice before and after internal biliary drainage. Summary Background Data Increased plasma levels of atrial natriuretic pepti de (ANP) have been found in patients with biliary obstruction. Methods Thirteen patients with newly diagnosed obstructive jaundice and no previous heart, lung, or renal disease were studied using a Swan-Ganz cathe ter. Hemodynamic measurements were taken before and 4 days after internal b iliary drainage. Levels of ANP and brain natriuretic peptide (BNP) were obt ained and liver function tests were also determined. Results Plasma levels of ANP and BNP were increased twofold to fourfold in the basal state and declined after biliary drainage. Independent variables predicting left ventricular systolic work were total bilirubin concentratio ns, duration of jaundice, and BNP. In addition, bilirubin concentrations co rrelated with pulmonary vascular resistance, mean arterial pulmonary pressu re, and right ventricular systolic work. Internal biliary drainage resulted in an improvement in left ventricular systolic work. A correlation was fou nd between decreasing ANP concentrations and increasing cardiac output. Conclusions Increased plasma levels of natriuretic peptides in patients wit h obstructive jaundice may reflect a subclinical myocardial dysfunction cor relating with the degree of jaundice. After internal biliary drainage, ther e is a measurable improvement of cardiac function.