Cardiac Output Response to Exercise in Patients with Inferior Vena Caval Ligation

Abstract

Studies were carried out to determine whether hemodynamic alterations may follow inferior vena caval (IVC) ligation. Five patients, aged 29 to 49 years, who had been operated upon 2 to 5 years previously, and five normal controls, aged 39 to 44 years, were studied at rest and during graded submaximal treadmill exercise. There were no significant differences in heart rate, right atrial pressure, brachial arterial pressure, oxygen consumption, or cardiac output between the patients and normals in the supine rest and head-up tilt positions. During treadmill exercise the heart rate and oxygen consumption were comparable in the two groups, but the cardiac output response was definitely diminished in the patient group. This was reflected in the exercise factor, that is, the increase in cardiac output per 100 ml increase in oxygen consumption. The mean exercise factor was 406 ml for the patient group and 726 ml for the controls, a significant difference ( P < 0.001). It is concluded that the cardiac output response to upright exercise may be impaired in patients with IVC ligation. Inadequate venous return following IVC ligation may explain the persistent postoperative exertional dyspnea that has been noted in our patients.

Reversal of cardiopulmonary exercise intolerance in patients with post-thrombotic obstruction of the inferior vena cava

“…In smaller case series, symptomatic patients with IVC ligation were characterized by limited increase in cardiac output during peak exercise by right heart catheterization [4], and limited peak oxygen uptake during cardiopulmonary exercise testing [7,8]. Measurements at anaerobic threshold may better reflect changes in cardiac hemodynamics in patients with initially low exercise capacity who may experience an improvement in PTS severity following endovascular intervention for two reasons: (1) many PTS patients do not fulfill the criteria of sufficient subject effort during cardiopulmonary exercise testing as confirmed by our study, (2) recanalization of the IVC is associated with improvement in PTS severity and venous claudication [10,15,16], and therefore may potentially improve peak exercise performance and VO 2 independent from cardiac effects.…”

“…In patients with IVC occlusion, limitations in exercise performance are often attributed to venous claudication or muscular deconditioning and not necessarily to impaired cardiac preload. First reports of patients with dyspnea on exertion, have been described in the context of IVC ligation [4][5][6]. In smaller case series, symptomatic patients with IVC ligation were characterized by limited increase in cardiac output during exercise assessed by right heart catheterization [4], and limited peak oxygen uptake during cardiopulmonary exercise testing [7,8].…”

“…First reports of patients with dyspnea on exertion, have been described in the context of IVC ligation [4][5][6]. In smaller case series, symptomatic patients with IVC ligation were characterized by limited increase in cardiac output during exercise assessed by right heart catheterization [4], and limited peak oxygen uptake during cardiopulmonary exercise testing [7,8]. These observations suggest but do not prove that cardiopulmonary exercise intolerance in patients with IVC ligation may be caused by reduced venous return to the heart and its incapability to adequately increase stroke volume and cardiac output during exercise [3,4,7].…”

Prone restraint cardiac arrest: A comprehensive review of the scientific literature and an explanation of the physiology

“…44 Patients who have undergone an IVC ligation experience a 45% reduction in CO in response to exercise compared to normal controls. 45 One recent publication reported the case of a patient who developed shock secondary to acute IVC occlusion. 46…”

Iliocaval Venous Obstruction, Cardiac Preload Reserve and Exercise Limitation

“…Exercise intolerance attributed to reduction in venous return from the lower limbs was first described by Varat et al in 1970 [ 37 ], who reported results from exercise right heart catheterisation in 5 patients who had previously undergone ligation of the inferior vena cava, and developed exertional dyspnoea post-operatively. None of the patients had any evidence of pulmonary hypertension.…”