HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Weisel, R. D. Articles by McLaughlin, P. R. Search for Related Content PubMed PubMed Citation Articles by Weisel, R. D. Articles by McLaughlin, P. R.

The Annals of Thoracic Surgery, Vol 36, 332-344, Copyright © 1983 by The Society of Thoracic Surgeons

ARTICLES

A comparison of volume loading and atrial pacing following aortocoronary bypass

RD Weisel, RJ Burns, RJ Baird, JD Hilton, J Ivanov, DA Mickle, KH Teoh, GT Christakis, PJ Evans, HE Scully, BS Goldman and PR McLaughlin

Although cold potassium cardioplegia provides adequate myocardial protection, transient hemodynamic and metabolic instability occasionally occurs after uncomplicated coronary bypass surgery. Two methods to increase cardiac output were compared 2 to 6 hours postoperatively in 24 patients recovering from elective coronary bypass operation. Volume loading increased cardiac index (CI) from 2.1 +/- 0.5 to 2.7 +/- 0.6 L/min/m2 by increasing left atrial pressure (LAP) from 8.6 +/- 3.6 to 13.0 +/- 4.1 mm Hg. Atrial pacing at a rate of 112 +/- 8 beats per minute increased CI from 2.4 +/- 0.5 to 2.7 +/- 0.8 L/min/m2 without a change in LAP. Ejection fraction by nuclear angiography did not change, but the calculated left ventricular end-diastolic volume index (stroke index/ejection fraction) increased with volume loading and decreased with atrial pacing--a decrease in diastolic compliance. Myocardial oxygen extraction did not change, but myocardial lactate extraction increased with volume loading and decreased with atrial pacing. Coronary sinus blood flow was measured in 5 patients and increased with both methods studied. Volume loading demonstrated that myocardial performance was normal and myocardial metabolism increased commensurate with the increase in work. Atrial pacing increased CI but resulted in anaerobic metabolism and a decrease in diastolic compliance. Volume loading rather than atrial pacing will improve CI without producing ischemia in the early postoperative period.

This article has been cited by other articles:

				M. D. Crittenden Intraoperative metabolic monitoring of the heart: I. Clinical assessment of coronary sinus metabolites Ann. Thorac. Surg., December 1, 2001; 72(6): S2220 - 2226. [Abstract] [Full Text] [PDF]