Reversal of Iatrogenic Myocardial Edema and Related Abnormalities of Diastolic Properties in the Pig Left Ventricle

Dean, David A.; Amirhamzeh, Mehrdad M.R.; Jia, Chao-Xiang; Cabreriza, Santos E.; Rabkin, David G.; Sciacca, Robert R.; Dickstein, Marc L.; Spotnitz, Henry M.

doi:10.1016/s0022-5223(98)70423-4

Cited by 10 publications

(3 citation statements)

References 23 publications

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“…Our previous studies of myocardial edema in the intact ventricle and isolated papillary muscle revealed linear correlations between diastolic properties, osmolarity of the coronary perfusates, and myocardial water content. 19,20 Limitations of our data include marginal control of variables affecting diastolic properties. Among these, heart rate did not change significantly after CPB; our data indicate minor effects of heart rate variability on diastolic properties.…”

Section: Discussionmentioning

confidence: 99%

Ventricular Diastolic Stiffness Predicts Perioperative Morbidity and Duration of Pleural Effusions After the Fontan Operation

et al. 2006

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Background-We validated the clinical relevance of ventricular stiffness by examining surgical morbidity in children with univentricular hearts undergoing Fontan operation. We hypothesized that ventricular stiffness affects Fontan morbidity, particularly duration of pleural effusions. Methods and Results-Sixteen children with right ventricular (RV) (n ϭ11) or left ventricular (LV) (n ϭ5) dominance were studied intraoperatively at a median age of 3.3 years (1.8 to 5.1). Transesophageal long-axis echocardiograms and ventricular pressure by micromanometer provided end-diastolic pressure (P) area (A) relations during initiation and conclusion of cardiopulmonary bypass. Curve fitting to the equation Pϭ␣e ␤A defined the ventricular stiffness constant, ␤. Changes in ␤ and clinical correlations were examined. Ventricular stiffness increased after bypass in patients with complete pre-bypass and post-bypass data (n ϭ11, Pϭ0.023, mixed models methodology). Pre-bypass ␤ correlated well with duration of chest tube (CT) drainage (rϭ0.90, n ϭ16), net perioperative fluid balance (rϭ0.71, nϭ14), and length of stay (LOS) (rϭ0.81, n ϭ16). CT duration and LOS also correlated significantly with post-bypass ␤ (rϭ0.77 for both, nϭ11), but insignificantly with preoperative catheterization pressures. Conclusions-Intraoperative

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Section: Discussionmentioning

confidence: 99%

Ventricular Diastolic Stiffness Predicts Perioperative Morbidity and Duration of Pleural Effusions After the Fontan Operation

et al. 2006

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“…Similar studies in a pig heart model reported that crystalloid-induced myocardial oedema and diastolic stiffness resolve after 45 min of reperfusion. 57,58 Hsu et al 59 reported that after 90 min of hypothermic ischaemic arrest, perfusion-induced myocardial oedema in dog hearts did not resolve completely when the coronary arteries were perfused with hypertonic solutions. Allen et al 60 investigated the effect of cardiac contractility on the resolution of myocardial oedema and myocardial lymph flow.…”

Section: Myocardial Oedema and Cardiac Functionmentioning

confidence: 99%

Myocardial microvascular permeability, interstitial oedema, and compromised cardiac function

Dongaonkar

Stewart

Geissler

et al. 2010

Cardiovascular Research

148

139

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The heart, perhaps more than any other organ, is exquisitely sensitive to increases in microvascular permeability and the accumulation of myocardial interstitial oedema fluid. Whereas some organs can cope with profound increases in the interstitial fluid volume or oedema formation without a compromise in function, heart function is significantly compromised with only a few percent increase in the interstitial fluid volume. This would be of little consequence if myocardial oedema were an uncommon pathology. On the contrary, myocardial oedema forms in response to many disease states as well as clinical interventions such as cardiopulmonary bypass and cardioplegic arrest common to many cardiothoracic surgical procedures. The heart's inability to function effectively in the presence of myocardial oedema is further confounded by the perplexing fact that the resolution of myocardial oedema does not restore normal cardiac function. We will attempt to provide some insight as to how microvascular permeability and myocardial oedema formation compromise cardiac function and discuss the acute changes that might take place in the myocardium to perpetuate compromised cardiac function following oedema resolution. We will also discuss compensatory changes in the interstitial matrix of the heart in response to chronic myocardial oedema and the role they play to optimize myocardial function during chronic oedemagenic disease.

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“…9,14 Reactive hyperemia and myocardial edema can occur suddenly and may produce measurable changes in LV mass over a few minutes. 37,58 These phenomena are not believed to render LV mass susceptible to variation during the cardiac cycle. The discussion that follows assumes that LV wall volume is constant.…”

Section: Compressibility Of the LV Wallmentioning

confidence: 99%

Macro design, structure, and mechanics of the left ventricle

Spotnitz

2000

The Journal of Thoracic and Cardiovascular Surgery

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Physiologic understanding of LV function can facilitate definition of the appropriate role for new procedures and help explain successes and failures. Thus enthusiasm for LV volume reduction has waxed and waned rapidly with little understanding of why the operation succeeded in some patients and failed in others, leaving uncertainty about who is an appropriate candidate for such surgery. Looking ahead, advances in surgical capacity to remodel and rearrange ventricular anatomy and an avalanche of new tools, including skeletal muscle grafts, mechanical assist devices, maze operations, pacing therapies for heart failure, and molecular and laser approaches to myocardial revascularization, will challenge our ability to understand new surgical tools and define their appropriate clinical role. The ability to meet this challenge begins with functional cardiac anatomy.This review summarizes current understanding of the relation between structure and function of the LV. Some areas in which such knowledge is incomplete and analytic methods are flawed are discussed. Illustration of how current understanding may contribute to further progress in clinical surgery is an underlying goal.

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Reversal of Iatrogenic Myocardial Edema and Related Abnormalities of Diastolic Properties in the Pig Left Ventricle

Cited by 10 publications

References 23 publications

Ventricular Diastolic Stiffness Predicts Perioperative Morbidity and Duration of Pleural Effusions After the Fontan Operation

Ventricular Diastolic Stiffness Predicts Perioperative Morbidity and Duration of Pleural Effusions After the Fontan Operation

Myocardial microvascular permeability, interstitial oedema, and compromised cardiac function

Macro design, structure, and mechanics of the left ventricle

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