Single, total paracentesis for tense ascites: sequential hemodynamic changes and right atrial size.
Hemodynamic changes induced by a single, total paracentesis were evaluated in 21 patients with tense ascites from whom 4 to 16 L of ascites were drained over 2 to 8 hr with no serious complications. At 60 min, compared to baseline, there was an increase in cardiac output (7.7 +/- 0.5 to 8.5 +/- 0.6 L/min, p less than 0.02) and a tendency for right atrial pressure to decrease (9.3 +/- 0.8 to 7.50 +/- 0.8 mm Hg, NS), with no change in pulmonary capillary wedge pressure (10.9 +/- 0.9 to 10.7 +/- 0.9 mm Hg). Between 3 and 12 hr later, there was a drop in right atrial pressure, pulmonary capillary wedge pressure and cardiac output to 5.6 +/- 0.6 (p less than 0.02), 7.2 +/- 0.8 mm Hg (p less than 0.002) and 7.2 +/- 0.6 L/min (NS) respectively, indicative of the development of relative hypovolemia and suggesting that therapeutic plasma expansion is appropriate at this time. Two-dimensional echocardiography before paracentesis (n = 8) showed a reduction in the right to left atrium area ratio as compared with values in patients with minimal ascites (0.54 +/- 0.04 vs 0.82 +/- 0.02, p less than 0.0001). This technique may help in identifying patients with right atrial compression caused by tense ascites.
Panos
M Z
MZ
Liver Unit, King's College Hospital School of Medicine and Dentistry, London, England.
Moore
K
K
Vlavianos
P
P
Chambers
J B
JB
Anderson
J V
JV
Gimson
A E
AE
Slater
J D
JD
Rees
L H
LH
Westaby
D
D
Williams
R
R
D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood; D001202:Ascitic Fluid / Q000473:pathology / Q000503:physiopathology* / Q000628:therapy; D009320:Atrial Natriuretic Factor / Q000097:blood; D004322:Drainage / Q000379:methods; D004452:Echocardiography; D006325:Heart Atria / Q000473:pathology; D006439:Hemodynamics; D006801:Humans; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D010952:Plasma Substitutes / Q000627:therapeutic use; D010953:Plasma Volume; D011677:Punctures; D012083:Renin / Q000097:blood
D010952:Plasma Substitutes; D000450:Aldosterone; D009320:Atrial Natriuretic Factor; D012083:Renin