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J Thorac Cardiovasc Surg 1995;109:796-803
© 1995 Mosby, Inc.

CARDIOPULMONARY BYPASS, MYOCARDIAL MANAGEMENT, AND SUPPORT TECHNIQUES

Right ventricular function evaluated by volumetric analysis during left heart bypass in a canine model of postischemic cardiac dysfunction

Kyoto, Japan

From the Department of Cardiovascular Surgery, Kyoto University Faculty of Medicine, Kyoto, Japan.

Received for publication Jan. 20, 1994. Accepted for publication August 4, 1994. Address for reprints: Mitsuru Kitano, MD, Department of Cardiovascular Surgery, Takeda Hospital, Higashiiru Shiokojidori-Nishinotoin, Shimogyo-ku, Kyoto 600, Japan.

Abstract

Right ventricular function during left heart bypass was evaluated by volumetric analysis with a conductance catheter in 12 dogs with postischemic cardiac dysfunction. The conductance catheter was used to assess the volumetric status of the right ventricle and thereby allowed a right ventricular pressure-volume curve to be obtained, in which transient volume loading on the right ventricle was applied. The following right ventricular properties during left heart bypass were assessed and compared with properties measured without left heart bypass, by means of load-independent parameters: maximum elastance, stroke work/end-diastolic volume relation, end-diastolic pressure/volume relation, and stroke work/end-diastolic pressure relation. The stroke volume derived from the conductance catheter and the electromagnetic flow probe showed good linear correlation (r² = 0.733 to 0.975). After initiation of left heart bypass, maximum elastance did not change significantly, although volume intercept significantly increased, from 1.2 ± 7.3 to 3.6 ± 7.9 ml (p < 0.05). End-diastolic pressure/volume relation was well fitted to the exponential curve (EDP = e ^{(k1 · EDV+k2)} ) and was shifted to the right and downward during left heart bypass; the slope k1 significantly decreased, from 0.12 ± 0.06 to 0.10 ± 0.07 (p < 0.01). Stroke work/end-diastolic volume relation and stroke work/end-diastolic pressure relation were closely fitted to the linear regression, and their slopes were significantly increased during left heart bypass, from 0.14 ± 0.08 to 0.18 ± 0.08 (p < 0.05) and from 0.22 ± 0.15 to 0.34 ± 0.19 (p < 0.01), respectively. These results suggest that the decompression of the left ventricle and septal shifting by left heart bypass provide good diastolic compliance and good systolic performance because of afterload unloading of the right ventricle. Thus the left heart bypass improved the overall right ventricular performance, particularly at higher end-diastolic pressures, in dogs with postischemic cardiac dysfunction. (J THORAC CARDIOVASC SURG 1995;109:796-803)

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