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J Thorac Cardiovasc Surg 1996;111:1092-1102
© 1996 Mosby, Inc.

CARDIOPULMONARY BYPASS, MYOCARDIAL MANAGEMENT, AND SUPPORT TECHNIQUES

ANALYSIS OF RIGHT VENTRICULAR FUNCTION DURING BYPASS OF THE LEFT SIDE OF THE HEART BY AFTERLOAD ALTERATIONS IN BOTH NORMAL AND FAILING HEARTS

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

Received for publication April 11, 1995 Accepted for publication July 26, 1995. Address for reprints: Chang-Hee Park, MD, Department of Cardiovascular Surgery, Kyoto University Faculty of Medicine, 54, Kawara-cho, Shogoin, Sakyo-ku, Kyoto 606, Japan.

Abstract

This study investigated the mechanism of right ventricular failure during bypass of the left side of the heart by precisely assessing right ventricular function with use of a conductance catheter. Bypass of the left side of the heart was established with a centrifugal pump in 10 mongrel dogs weighing 11 to 19 kg. Right ventricular function during left heart bypass was evaluated by two parameters that were both derived from measurement of relative change in right ventricular volume by the conductance catheter technique. One parameter was the right ventricular end-systolic pressure-volume relationship as a load-independent index, and the other was the peak right ventricular pressure–right ventricular stroke volume relationship as a "force-velocity relationship." These parameters were measured in both normal and failing hearts while afterload was increased by bilateral intrapulmonary balloon inflation. Moreover, changes in these relationships were observed by varying assist ratios of left heart bypass from 0% to 100%. Failing heart models were induced by normothermic aortic clamping for 20 minutes. The right ventricular end-systolic pressure-volume relationship in normal hearts did not change, irrespective of the assist ratio of left heart bypass, whereas that in failing hearts decreased from 4.25 ± 1.41 mm Hg/ml without bypass of the left side of the heart to 3.53 ± 1.30 mm Hg/ml after 100% assist of left heart bypass (p < 0.05). In the peak right ventricular pressure–right ventricular stroke volume relationship, right ventricular stroke volume was almost constant in normal hearts when afterload was increased regardless of the assist ratio of left heart bypass. Moreover, right ventricular stroke volume was maintained at a higher level during bypass of the left side of the heart compared with that without left heart bypass. However, that slope of the relationship in failing hearts was inversely linear and became significantly steeper after 100% assist of bypass of the left side of the heart compared with that without left heart bypass (-0.131 ± 0.042 versus -0.051 ± 0.038, p < 0.005). Therefore these two slopes of the relationship intersected at a point that was considered the critical point of afterload during bypass of the left side of the heart. In other words, right ventricular stroke volume was decreased by 100% left heart bypass above the critical point of afterload. In conclusion, this study demonstrates not only that bypass of the left side of the heart results in an increase in right ventricular stroke volume in both normal and failing hearts at the physiologic range of afterload, but also that right ventricular function against higher afterload is impaired by 100% assist of bypass of the left side of the heart in failing hearts.(J THORACCARDIOVASCSURG1996;111:1092-1102)

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