Circulation, Vol 89, 180-190, Copyright © 1994 by American Heart Association
J Gorcsan 3rd, TA Gasior, WA Mandarino, LG Deneault, BG Hattler and MR Pinsky
BACKGROUND: Pressure-volume relations have been established as useful
measures of left ventricular (LV) performance. Application of these methods
to the intraoperative setting have been limited because of difficulties
acquiring LV volume data. Transesophageal echocardiographic automated
border detection can measure LV cross- sectional area as an index of
volume, which can be coupled with pressure data to construct pressure-area
loops on-line. The purpose of this study was to evaluate intraoperative LV
performance in patients undergoing coronary bypass surgery before and
immediately after cardiopulmonary bypass using on-line pressure-area
relations. METHODS AND RESULTS: Studies were attempted in 13 consecutive
patients. Simultaneous measures of LV cross-sectional area, LV pressure,
and electromagnetic flow probe-derived aortic flow recorded on a computer
work station interfaced with the ultrasound system. Pressure-area loops
were compared with simultaneous pressure-volume loops constructed from
pressure and flow data during inferior vena caval occlusions before and
after bypass. Pressure-volume calculations (end-systolic elastance, maximal
elastance, and preload-recruitable stroke work) were then applied to
pressure-area loops with area substituted for volume data. Changes in
stroke force from pressure-area loops were closely correlated with changes
in estimates of stroke work from pressure- volume loops for individual
patients before bypass (r = .99 +/- .03, SEE = 5 +/- 2%, n = 10) and after
bypass (r = .96 +/- .05, SEE = 5 +/- 2%, n = 9). Pressure-area estimates of
end-systolic elastance, maximal elastance, and preload-recruitable stroke
force decreased significantly from before to after cardiopulmonary bypass
in the 7 patients with paired data sets. Load-dependent measures of LV
function (stroke volume, cardiac output, and fractional area change) were
unchanged after surgery in these same patients. CONCLUSIONS: Intraoperative
pressure-area loops may be acquired and displayed on-line using
transesophageal echocardiographic automated border detection and readily
analyzed in a manner similar to pressure-volume loops. LV performance was
depressed immediately after cardiopulmonary bypass compared with before.
On-line pressure-area relations may be clinically useful to assess LV
performance in patients undergoing cardiac surgery in whom load and
contractility may be expected to vary rapidly.
ARTICLES
Assessment of the immediate effects of cardiopulmonary bypass on left ventricular performance by on-line pressure-area relations
University of Pittsburgh Medical Center, PA 15261.
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