title: Pericardiotomy improves left ventricular compliance during sepsis-induced pulmonary artery hypertension.
abstract: Sepsis-induced pulmonary artery hypertension (SIPAH) causes an increase in right ventricular (RV) afterload, dilatation of the RV, leftward shift of the interventricular septum (IVS), and therefore decreases left ventricular compliance (LVC). This study was designed to evaluate the role of pericardiotomy during SIPAH as an alternative to vasodilators (which cause a detrimental increase in shunt fraction) to improve LVC. Systemic and pulmonary hemodynamics, pulmonary function, RV, and LVC were acquired at baseline (BL), during SIPAH with closed pericardium (PAHCP) and after opening the pericardium (PAHOP). Systemic hemodynamics and pulmonary function did not change significantly during the experiment. The infusion of live bacteria induced a significant rise in mean pulmonary artery pressure from 16 +/- 5.3 at BL to 36.8 +/- 3.3 and 35.0 +/- 6.4 mm Hg during PAHCP and PAHOP, respectively, (P less than 0.05). Pulmonary vascular resistance index and right ventricular stroke work index (RVSWI) displayed a similar rise in response to SIPAH (P less than 0.05 vs BL). Pericardiotomy did not affect pulmonary hemodynamics or RVSWI. Right ventricular contractility did not increase following pulmonary hypertension while the pericardium was closed (440 +/- 78 vs 410 +/- 125, P less than 0.05); however, it rose, although not significantly, to 615 +/- 326 after pericardiotomy. RV time tension index displayed a rise during SIPAH with the pericardium intact and returned to baseline values after pericardiotomy; however, these changes were not significant. RVC did not change significantly throughout the experiment. In contrast, LVC decreased significantly after SIPAH and significantly improved after pericardiotomy.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Surgery, Maimonides Medical Center, Brooklyn, New York.
authors.forename: M S
authors.initials: MS
authors.lastname: Coons
authors.forename: T T
authors.initials: TT
authors.lastname: Woloszyn
authors.forename: T A
authors.initials: TA
authors.lastname: Folliguet
authors.forename: C
authors.initials: C
authors.lastname: Rodriguez
authors.forename: R
authors.initials: R
authors.lastname: Levy
authors.forename: R
authors.initials: R
authors.lastname: Maughan
authors.forename: I M
authors.initials: IM
authors.lastname: Nathan
authors.forename: C P
authors.initials: CP
authors.lastname: Marini
mesh_terms: D000818:Animals; D001794:Blood Pressure / Q000502:physiology; D003187:Compliance; D004195:Disease Models, Animal; D006976:Hypertension, Pulmonary / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D010492:Pericardiectomy; D011552:Pseudomonas Infections / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D013552:Swine; D016277:Ventricular Function, Left / Q000502:physiology*