Fourteen patients underwent right heart catheterization 5 to 86 months after pericardiectomy for constrictive pericarditis. Twelve had preoperative catheterizations, all with findings typical of constrictive pericarditis. All patients showed marked hemodynamic and symptomatic improvement after operation. Three patients had persistent mild elevation of right heart and pulmonary artery pressures; one of these had a low cardiac output. Two other patients developed pulmonary hypertension with exercise, and one man showed an inadequate increase in cardiac output with exercise. Twelve patients were asymptomatic postoperatively and two had exertional dyspnea. Patients with incomplete pericardiectomy over the ventricles had abnormal hemodynamic results, while decortication of the atria and venae cavae made no difference in the postoperative findings. A left anterolateral thoracotomy incision provided adequate exposure for pericardiectomy, and continues to be the incision of choice at this hospital. Younger patients and those who progressed from recognized acute pericarditis to pericardial constriction more frequently had normal results at cardiac catheterization after operation. Certain preoperative liver-function tests correlated well with the postoperative hemodynamic findings. The role of myocardial disease in producing residual hemodynamic abnormalities remains unresolved. It is concluded that excellent clinical results and normal hemodynamic findings can be achieved by pericardiectomy in most patients with constrictive pericarditis.
A safe, rapid method for estimating left ventricular volume in man during the course of hemodynamic studies should prove helpful in the assessment of cardiac disease and useful in physiological research. It is the purpose of this report to present left ventricular volume measurements in man that were obtained by an indicator dilution method which employs cold as the indicator. This circulatory indicator has been studied by several workers (1-4) and has been used for left ventricular volume determinations in animals previously (5-10). The method employed was adapted from those used by Rapaport and his co-workers for left ventricular volume measurements in the dog (7) and right ventricular studies in man (11). MethodsThirty-eight patients were studied during diagnostic left heart catheterization. The left ventricle was catheterized by the percutaneous transseptal method, utilizing a Teflon catheter which has four side holes near its tip (12). Left atrial pressure was measured before and after ventricular catheterization. A brachial artery was cannulated percutaneously with a 15-cm length of polyethylene tubing. A 6F Teflon catheter was introduced percutaneously into the right femoral artery and advanced until its tip was slightly above the aortic valve, as judged fluoroscopically. Left heart pressures were measured with a P-23G strain gage' and systemic arterial pressure with a P-23D gage.' These pressures and the electrocardiogram were recorded with a direct-writing four channel oscillograph. system and that it present an exponential series of decreasing, steplike concentrations. In these studies cold was used as the indicator and was delivered rapidly into the left ventricle by injections of 5 ml of cooled saline. Rarely, 10-to 15-ml injections were given in patients with extremely large ventricular volumes. A bead thermistor in the proximal aorta served as the sampling system. The thermistor catheter was of nylon (o. d., 0.97 mm) with a closed end and had a rapidly responding thermistor bead mounted at its tip.3 This catheter was 1 cm longer than the radiopaque aortic catheter and was inserted into the latter when thermodilution curves were to be recorded. This placed the thermistor into the blood stream just above the aortic valve. Immediately after recording the thermodilution curves and cardiac output by dye dilution, the aortic catheters were removed to avoid the possibility of thrombosis.The thermistor was employed as one arm of a Wheatstone bridge that was activated by a mercury battery. Approximately 0.1 v was presented to the thermistor itself. The resulting signal was amplified by a type 53/54 D preamplifier4 and displayed with a type RM 565 oscilloscope.4 The electrocardiogram was displayed simultaneously by a type 3 A 74 amplifying electronic switch.4 Records were made by photographing the oscilloscope screen with 35-mm film.The thermistors were calibrated against known temperature in a water bath. The peak change in aortic blood temperature produced by the cold inj ections was usually between 0.3°an...
Under the supervision of Richard W. Eckstein, M.D. The possibility that nitroglycerin modifies the metabolic effects of the sympathominietic amines wits tested in cats. Changes in the heart rate, blood pressure, height of the electrocardiographic T-wave and myoctirdial oxygen consumption following the injection of epinephrine or 1-arterenol were compared with changes in these indices after nitroglycerin was given with these sympathomimetic amines. The conclusion is reached that nitroglycerin does not significantly influence the effects of epinuphrine or 1-arterenol on the heart rate, the height of the electrocardiographic Twave or myocardial oxygen consumption. There is no evidence in these experiments to support the concept that nitroglycerin metabolicallv neutralizes the myocardial anoxating properties of the sympathomimetic amines.T HE exact cause of the benefit derived from nitroglycerin in the anginal syndrome is far from clear. Usually it is attributed to improved myocardial oxygenation resulting from coronary dilation and/or reduced peripheral resistance with a reduction in myocardial oxygen requirement. Recently, Raab 1 • 2 has suggested that the effect of nitroglycerin in the anginal syndrome depends on a metabolic neutralization of the anoxating properties of the sympathomimetic agents on the myocardium. The evidence for this hypothesis is based upon electrocardiographic and heart rate changes in atropinized cats. Raub observed that the T-wave depression and the heart rate acceleration induced by commercial adrenaline and by 1-arterenol were prevented when nitroglycerin was given prior to or in combination with these drugs. In the From the Departments of Medicine and Physiology, Western Reserve University School of Medicine, Cleveland, Ohio. This investigation was undertaken in partial fulfillment of the requirements for tho Phase I and If curriculum of the academic years 1053-1955. present study the experimental work of Raab was repeated and experiments giving a direct index of myocardial metabolism were performed. METHODSPart I. Fifteen cats were anesthetized with pentobarbitnl and after cannulation of the left jugular vein the blood was rendered noncoagulable with heparin (50 mg.). The right carotid artery was cannulated and connected to a Gregg manometer 1 for optical recording of blood pressure. Electrocardiograms from lead CR4 and blood pressure were simultaneously recorded during and after drug administration.The cats were atropinized (2 mg./Kg.) and control records were obtained. The separate effects of adrenalin,* adrenalin with nitroglycerin, and nitroglycerin alone were mciisuifcl. The drugs were given slowly with a motor driven syringe or injected rapidly into the left jugular vein and were followed by a 5 ml. saline wash. Each injection was made 5 min. subsequent to the disappearance of the observable effects of the previous drug. The effects of 1-arterenolf alone and together with nitroglycerin were also studied. Fifty micrograms of adrenaline and 1-arterenol and from ] to 10 mg. of nitr...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.