This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Attia, R. R. Articles by Lowenstein, E. Search for Related Content PubMed PubMed Citation Articles by Attia, R. R. Articles by Lowenstein, E.

Circulation, Vol 53, 961-965, Copyright © 1976 by American Heart Association

ARTICLES

Myocardial ischemia due to infrarenal aortic cross-clamping during aortic surgery in patients with severe coronary artery disease

RR Attia, JD Murphy, M Snider, DG Lappas, RC Darling and E Lowenstein

Hemodynamic measurements were performed and ECG recorded before and shortly after infrarenal aortic cross-clamping during operation for abdominal aortic aneurysm in five patients without evidence of heart disease (group I) and in ten patients with severe coronary artery disease (group II). All patients sustained an increase in systemic arterial pressure. Group I demonstrated a decrease in pulmonary artery, pulmonary capillary wedge (PCW), and central venous pressures when the aorta was clamped, whereas group II demonstrated an increase. The difference in response of the groups is significant (P less than 0.05). All three patients who responded to cross-clamping with increases of 7 mm Hg or greater in PCW demonstrated myocardial ischemia during cross- clamping. None of the values measured prior to cross-clamping predicted with certainty the response to cross-clamping. Sodium nitroprusside reversed the elevation of left ventricular filling pressure in all three patients, and in two patients, relieved evidence of myocardial ischemia concurrently. In the third patient, ventricular irritability was abolished by lidocaine and did not recur. We conclude that infrarenal aortic cross-clamping may cause myocardial ischemia in patients with severe coronary artery disease. This ischemia may be predicted by a rise in PCW at the time of cross-clamping, and vasodilator therapy is indicated in such patients.

This article has been cited by other articles:

				H. Ohuchi, M. Kato, H. Asano, H. Tanabe, M. Ogiwara, K. Imanaka, S. Gojo, Y. Yokote, and S. Kyo Combined Coronary Artery Bypass Grafting and Abdominal Aortic Aneurysm Repair Asian Cardiovasc Thorac Ann, September 1, 2003; 11(3): 233 - 236. [Abstract] [Full Text]

				J. McGinley, L. Lynch, K. Hubbard, D. McCoy, and A.J. Cunningham Dopexamine hydrochloride does not modify hemodynamic response or tissue oxygenation or gut permeability during abdominal aortic surgery Can J Anesth, March 1, 2001; 48(3): 238 - 244. [Abstract] [Full Text] [PDF]

				J.-S. Jin and L. G. D'Alecy Stimulation of Endogenous Nitric Oxide Pathway by L-Arginine Reduces Declamp Mortality and Attenuates Hypertension Associated With Aortic Cross-Clamp–Induced Hindlimb Ischemia in Rats Hypertension, September 1, 1995; 26(3): 406 - 412. [Abstract] [Full Text]

				F.W. Mohr, V. Falk, R. Autschbach, A. Diegeler, B. Schorn, A. Weyland, M. Vettelschoß, B. Frank, J. Gummert, and H. Dalichau One-Stage Surgery of Coronary Arteries and Abdominal Aorta in Patients With Impaired Left Ventricular Function Circulation, January 15, 1995; 91(2): 379 - 385. [Abstract] [Full Text]

				T. Carrel, M. Pasic, E.R. Schmid, and M. Turina Cardiac and Hemodynamic Effects of Infrarenal Aortic Clamping During Repair of Abdominal Aortic Aneurysms. A Reason for Combined Coronary Bypass and Aneurysm Repair in Patients with Severe Coronary Artery Disease Vascular and Endovascular Surgery, June 1, 1993; 27(5): 337 - 343. [Abstract] [PDF]

				M. Nakatsuka, A. K. Gupta, and M. P. Posner The Effects of Fluid Loading on Hemodynamic Changes and Right Ventricular Function with Aortic Unclamping During Abdominal Aortic Surgery Vascular and Endovascular Surgery, May 1, 1993; 27(4): 282 - 287. [Abstract] [PDF]