Sg. De Hert et al., The effects of the pericardium on length-dependent regulation of left ventricular function in coronary artery surgery patients, J CARDIOTHO, 15(3), 2001, pp. 300-305
Objective: To analyze the effects of the pericardium on the length-dependen
t regulation of myocardial function in coronary artery surgery patients.
Designs Prospective.
Setting: University hospital.
Participants: Patients scheduled for elective coronary artery surgery.
Interventions: In 10 patients, a combined micromanometer transducer conduct
ance catheter was inserted into the left ventricle for measurement of left
ventricular pressures and volumes.
Measurements and Main Results: Consecutive data were obtained during a prog
ressive increase in Left ventricular pressures and volumes obtained by leg
elevation in closed chest-closed pericardium and open chest-open pericardiu
m conditions. Pericardiotomy did not alter baseline left ventricular hemody
namics. The effects of leg elevation were different, however. In closed che
st-closed pericardium conditions, stroke volume and stroke work remained un
changed, whereas these parameters increased in open chest-open pericardium
conditions. This increase was related to the increase in end-diastolic volu
me that was observed in open chest-open pericardium conditions and not in c
losed chest-closed pericardium conditions.
Conclusions: In coronary artery surgery patients, pericardiotomy does not a
lter baseline left ventricular function. When cardiac load is increased by
leg elevation, however, use of the Frank-Starling mechanism is enhanced in
open: chest-open pericardium conditions. Copyright (C) 2001 by W.B. Saunder
s Company.