Assessment of left ventricular functional preservation during isolated cardiac valve operations.
To evaluate intraoperative changes in myocardial performance during valvular operations, ventricular functional measurements were obtained in 16 patients before and after elective cardiac valvular replacement. Six patients had mitral regurgitation, four had mitral stenosis, and six had calcific aortic stenosis; all patients underwent isolated mitral or aortic valve replacement. Cold potassium crystalloid cardioplegia, topical hypothermia, and low-flow systemic hypothermia were employed uniformly. Just before and 10 minutes after cardiopulmonary bypass was discontinued, left ventricular pressure and volume data were recorded at four to five different steady-state levels of filling produced by blood infusion or withdrawal from the aortic cannula (mean end-diastolic pressure range, 10-22 mm Hg; mean end-diastolic volume range, 120-168 ml). Portable first-pass radionuclide ventriculography and simultaneous micromanometry were used for construction of left ventricular pressure-volume loops from which stroke work and end-diastolic volume were calculated. Two-dimensional transesophageal echocardiograms also were recorded, and epicardial pacing maintained heart rate as constant as possible. As compared with prebypass measurements, echocardiographic left ventricular wall volume changed insignificantly after the valvular procedures (178-181 ml/m2, p greater than 0.5). The stroke work-end-diastolic volume relationship before and after operation was highly linear in all studies (mean = 0.97). The slope and x intercept of this relationship did not change significantly after operation, indicating a stable level of left ventricular function (from 12.7 x 10(4) to 10.0 x 10(4) ergs/ml and from 67 to 57 ml, respectively; p greater than 0.3).(ABSTRACT TRUNCATED AT 250 WORDS)
Harpole, DH; Rankin, JS; Wolfe, WG; Smith, LR; Young, WG; Clements, FM; Jones, RH
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