Effects of Upright Posture and Exercise on Pulmonary Hemodynamics in Patients with Central Cardiovascular Shunts

Bruce, Robert A.; John, Gregory G.; Wiederhielm, Curt A.; Hamilton, Charlotte; Morgan, Claire; Kendall, Elizabeth

doi:10.1161/01.cir.16.5.776

Cited by 17 publications

(4 citation statements)

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“…In the presence of pulmonary hypertension, the pulmonary blood flow appears to be relatively fixed (Figure 1), although a small increase was demonstrated during exercise. Bruce and John (8) reported that arterial desaturation occurred in two of their patients, but they did not report a fixed pulmonary blood flow. It is not possible to state that the increase in.…”

Section: Changes In Pulmonary Vascular Dynamicsmentioning

confidence: 93%

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The Effect of Exercise in the Supine Position on Pulmonary Vascular Dynamics in Patients With Left-to-Right Shunts

Swan¹,

Marshall²,

Wood³

1958

J. Clin. Invest.

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The effect of exercise on pulmonary artery pressure, blood flow, and resistance has been studied extensively in normal subjects (1-5), and in patients with rheumatic heart disease (6, 7). However, only brief reports have appeared concerning the response of patients with intracardiac or great vessel shunts (8,9). The dearth of published information probably is due in part to uncertainty as to the exact diagnosis in a sufficient number of cases. This paper concerns the changes in pulmonary and systemic blood flows, pressures, and resistances, and the associated variations in intracardiac or aortopulmonary shunts caused by leg exercise in the supine position in 30 patients with single congenital anomalies. In those patients with pulmonary hypertension the pulmonary blood flow was found to change only slightly during exercise irrespective of the magnitude of the left-toright shunt, while pulmonary artery pressure and pulmonary resistance values were increased. In patients without pulmonary hypertension there was a more definite increase in pulmonary blood flow; but as in the preceding group, a decrease was observed in the magnitude of the left-to-right shunt. Complete data for accurate anatomic appraisal had been obtained in all instances, and operative confirmation of the diagnosis was available in the great majority. METHODS AND MATERIALSProcedure. The following procedure was adhered to, with minor variations. The patient received 0.5 grain (30 mg.) of codeine and 1.5 grains of secobarbital (Seconal®) immediately prior to the start of the procedure. He lay supine on a horizontally positioned fluoroscopy table. A No. 5 or 6 Cournand cardiac catheter (designated catheter 1) was introduced, usually by percutaneous needle puncture of a vein in the right antecubital fossa (10) and advanced to the heart. Oxy-'The Mayo Foundation, Rochester, Minnesota, is a part of the Graduate School of the University of Minnesota.gen saturations of blood samples obtained from various locations within the heart and great vessels were measured by a cuvette oximeter (11) to ascertain the oxygen saturation of the mixed venous blood and to determine the magnitude and location of the left-to-right shunt. The catheter tip was located in the main pulmonary artery, and a needle was inserted into a radial artery. Pressures in the systemic and pulmonary artery systems were recorded by means of strain-gauge manometers. It was desirable in a number of patients to obtain simultaneously samples of blood from the inferior vena cava as well as from the pulmonary artery. To make this possible a second catheter (designated catheter 2) was inserted and advanced directly into the inferior vena cava. The rate of oxygen consumption was then determined by collection of the expired air for five minutes in a largevolume, low-resistance plastic balloon. Analysis of the expired air was carried out immediately by the Haldane method. Midway during the period of collection of expired air, blood samples were obtained for analysis of the oxygen content by the method o...

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Section: Changes In Pulmonary Vascular Dynamicsmentioning

confidence: 93%

“…However, only brief reports have appeared concerning the response of patients with intracardiac or great vessel shunts (8,9). The dearth of published information probably is due in part to uncertainty as to the exact diagnosis in a sufficient number of cases.…”

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confidence: 99%

The Effect of Exercise in the Supine Position on Pulmonary Vascular Dynamics in Patients With Left-to-Right Shunts

Swan¹,

Marshall²,

Wood³

1958

J. Clin. Invest.

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“…We cannot agree with this conclusion when applied to the group of cases with ASD and hyperkinetic pulmonary hypertension. Bruce and John (1957) studied patients with ASD, VSD, and PDA at rest and on exercise in the upright position, measuring only the pulmonary flow. They found a larger increase in this than the anticipated rise of systemic flow, indicating an increased left-to-right shunt with effort.…”

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confidence: 99%

Haemodynamic changes on exercise in patients with left-to-right shunts.

Davies¹,

Gazetopoulos²

1966

Heart

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There have been several studies of the effect of exercise on the htmodynamics in patients with cardiac septal defects and left-to-right shunts (Jonsson, Linderholm, and Pinardi, 1957;Scebat et al., 1957;Bruce and John, 1957;Swan, Marshall, and Wood, 1958;Stephens, Shafter, and Bliss, 1964), but some uncertainty remains about the conclusions. Since any attempt to understand the disability of such patients depends on these, we have attempted a further investigation into the changes occurring during exercise. This paper deals with the hemodynamics, and a following communication is concerned with ventilatory and metabolic aspects (Gazetopoulos and Davies, 1966). SUBJECTS AND METHODSStudies were carried out on 34 patients, 18 with atrial septal defect (ASD), 12 with ventricular septal defect (VSD), and 4 with patent ductus arteriosus (PDA).The hemodynamic studies were performed during cardiac catheterization in the supine position. Routine data having been first obtained, a catheter was left in the pulmonary artery and an indwelling needle in a brachial artery. Spirometry was carried out and blood samples were taken; the catheter was then withdrawn to the lateral wall of the right atrium and further blood samples were obtained. In patients with ASD a second catheter, placed in the inferior vena cava, was withdrawn to the superior vena cava for further sampling. Paired samples were thus obtained from brachial artery, pulmonary artery, right atrium, or cavae for flow determinations by the Fick principle. Dye-dilution curves were also inscribed, as described below.The catheters were then replaced in their original sites and the patient exercised with either a springloaded leg exerciser (earlier studies) or a bicycle ergometer (Elema-Schonander-later studies). Pulmonary and brachial arterial pressures were continuously monitored and, after the fifth minute of exercise, Received July 21, 1965. * Present address: Alex. Soutson 8, Athens 134, Greece. 579 spirometry was repeated with the same sampling sequence as described above. Dye-dilution curves were also recorded during exercise. The spirometer was of the closed-circuit type (Donald and Christie, 1949) and oxygen consumption was corrected to STPD. Blood oxygen saturations were measured spectrophotometrically (Unicam model 600).As representative of mixed venous saturation we have used the mean of right atrial samples where the shunt was distal to this level, while in ASD the mean of two inferior caval and one superior caval value was taken. Dye-dilution curves were recorded on a Mark II Cambridge dye recorder with a high-resistance input circuit giving a linear response to concentration of dye (Gabe and Shillingford, 1961), Coomassie blue being used as indicator. Special attention was paid to injecting the same quantity of dye at the same site just above the pulmonary valve at rest and on exercise. The curves were replotted and extrapolated on semi-logarithmic paper, and the shunt calculated as a percentage of the pulmonary flow by planimetry. In cases with large leftto-r...

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Der Aludrin-Test: Nachahmung körperlicher Belastung bei der Untersuchung von Kindern mit angeborenen Herzfehlern

Keck

1965

Herzklappeninsuffizienz

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Effects of Upright Posture and Exercise on Pulmonary Hemodynamics in Patients with Central Cardiovascular Shunts

Cited by 17 publications

References 10 publications

The Effect of Exercise in the Supine Position on Pulmonary Vascular Dynamics in Patients With Left-to-Right Shunts

The Effect of Exercise in the Supine Position on Pulmonary Vascular Dynamics in Patients With Left-to-Right Shunts

Haemodynamic changes on exercise in patients with left-to-right shunts.

Der Aludrin-Test: Nachahmung körperlicher Belastung bei der Untersuchung von Kindern mit angeborenen Herzfehlern

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