Analysis of diastolic function in patients undergoing aortic aneurysm repair and impact on hemodynamic response to aortic cross-clamping

Objectives: The purpose of this study was to analyze left ventricular diastolic function in patients undergoing aortic aneurysm repair and to investigate the effects of laparotomy and aortic cross-clamping on diastolic function. Design: Prospective clinical study. Setting: University hospital. Parti...

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Bibliographic Details
Published in:Journal of cardiothoracic and vascular anesthesia 2005-04, Vol.19 (2), p.165-172
Main Authors: Meierhenrich, Rainer, Gauss, Albrecht, Anhaeupl, Thomas, Schütz, Wolfram
Format: Article
Language:English
Subjects:
Aged
Anesthesia
Aorta - physiology
Aortic Aneurysm - surgery
aortic cross-clamping
Catheterization, Peripheral
Constriction
delayed relaxation
Diastole
Echocardiography
Female
Hemodynamics - physiology
Humans
Laparotomy
left ventricular diastolic function
Male
Middle Aged
Prospective Studies
pseudonormal filling
Pulmonary Artery - physiology
Stroke Volume - physiology
transesophageal echocardiography
Vascular Surgical Procedures
Ventricular Function, Left - physiology
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Summary:Objectives: The purpose of this study was to analyze left ventricular diastolic function in patients undergoing aortic aneurysm repair and to investigate the effects of laparotomy and aortic cross-clamping on diastolic function. Design: Prospective clinical study. Setting: University hospital. Participants: Forty-five consecutive patients undergoing open aortic aneurysm repair. Interventions: Left ventricular diastolic function and hemodynamic variables were evaluated using transesophageal Doppler echocardiography and a pulmonary artery catheter at baseline, after laparotomy, and at 1 and 10 minutes after cross-clamping. Diastolic function was determined by Doppler derivatives of mitral inflow (E/A ratio, deceleration time of early inflow) and pulmonary venous flow (S/D ratio). Measurements and main results: Twenty of 39 patients revealed signs of diastolic dysfunction at baseline. Of these 20 patients, 14 displayed delayed relaxation and 6 displayed a pseudonormal filling pattern. Patients with pseudonormal filling exhibited a lower stroke volume ( p = 0.02) and cardiac index ( p < 0.01) in comparison to patients with normal diastolic function. Laparotomy was associated with an improvement of diastolic function in 9 of 20 patients with preexisting diastolic dysfunction. Only 3 patients suffered impairment of diastolic function after cross-clamping. The hemodynamic response to cross-clamping did not differ between patients with normal and abnormal diastolic function. Conclusions: About 50% of patients undergoing aortic aneurysm repair exhibit signs of diastolic dysfunction. The majority of these patients showed delayed relaxation. Patients with pseudonormal filling displayed a significantly lower cardiac index. Laparotomy resulted in an improvement in diastolic function in about half of patients with preexisting diastolic dysfunction. The effects of cross-clamping on diastolic function are minimal.
ISSN:1053-0770
1532-8422
DOI:10.1053/j.jvca.2005.01.025