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The Journal of Thoracic and Cardiovascular Surgery, Vol 71, 1-10, Copyright © 1976 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

The contribution of atrial contraction to right heart function before and after right ventriculotomy. Experimental and clinical observations

RA Guyton, MJ Andrews, PR Hickey, LL Michaelis and AG Morrow

Effective atrial contraction was abolished by simultaneous atrial and ventricular (A-V) pacing in an acute canine preparation. At constant cardiac output, aortic pressure, and heart rate, only a small rise (1.4 mm. Hg) in mean right atrial pressure was observed before vertical right ventriculotomy, but a larger rise (9.5 mm Hg) occurred after ventriculotomy (p less than 0.01). Right heart failure with tricuspid regurgitation was induced after ventriculotomy by volume overload and A- V pacing. Restoration of atrial contraction (sequential A-V pacing) eliminated regurgitation and lowered average mean right atrial pressure from 22 to 4 mm. Hg (p less than 0.001). After right ventriculotomy, loss of atrial contraction at a constant right atrial pressure resulted in a 42 per cent reduction in cardiac output. In 8 patients who had had right ventriculotomies, abolition of effective atrial contraction by A- V pacing caused an average reduction in cardiac output of 22 per cent, whereas cardiac output fell only 5 per cent in 5 control patients (p less than 0.01).

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