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Thorac Cardiovasc Surg 1985; 33(4): 230-234
DOI: 10.1055/s-2007-1014127
© Georg Thieme Verlag Stuttgart · New York

Hemodynamics during and Immediately after the Surgical Creation of a Supravalvular Pulmonary Stenosis in Pigs

P. E. Lange1 , K. R. Schirmer1 , H. S.H. Jaeger1 , H. H. Sievers2 , D. G.W. Onnasch1 , P. H. Heintzen1
  • 1Department of Pediatric Cardiology, and
  • 2Department of Cardiovascular Surgery, University of Kiel, FRG
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Publication History

1985

Publication Date:
19 March 2008 (online)

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Summary

The surgical creation of a supravalvular pulmonary Stenosis (PS) adequate to prepare the left ventricle (LV) for anatomic correction in cases of simple transposition of the great arteries (TGA) is difficult.

To gain more information on the hemodynamic changes immediately following PS of various degrees, pressures (P) in the right atrium (RA), right ventricle (RV), pulmonary artery (PA) and left ventricle (LV) as well as pulmonary flow (F) were monitored 40 minutes (30 to 50 minutes after PS (n = 15) in 10 open chested pigs (mean weight: 20.7 kg).

Hemodynamic changes can be separated into an adaptation phase (AP) with an “overshoot” response of most hemodynamic Parameters and a stable phase (SP) without further changes, reached after 6.5 minutes (1 to 18 minutes). This pattern was independent of the degree of PS (increase of RV Pmax: 13 to 39 mmHg). Maximal changes (p<0.01) during AP included: RV Pmax: +25 ± 9 mmHg, RV EDP: +6 ± 3 mmHg, RV dp/dt max: +315 ± 208 mmHg/sec, LV Pmax: -43 ± 24 mmHg, PA max. syst, flow: -0.3 ±0.15 ml/sec, CO: -0.45 ± 0.3 l/min. During SP, LV Pmax and PA Pmean werp normal. RV EDP and RA Pmean had decreased (p < 0.01) but remained elevated as compared to the control values (p < 0.01)., The right ventricular maximal pressure had decreased 30% but remained elevated compared to control values (p<0.01). A change of RV Pmax during SP correlated (r = 0.93) with the maximal change of RV Pmax during AP.

A final evaluation of the degree of PS is only possible after an average period of 6.5 minutes. It is dependent on its maximal change during AP. During AP, significant reduction of flow and systematic pressure can be anticipated. An acute pressure load of RV up to 100% is associated with a significant increase of RV EDP and RA Pmean as well as a decrease of maximal systolic pulmonary flow.

Key words

Pulmonary artery banding - Right ventricular pressure loading - Right ventricular function - Transposition of the great arteries