title: The pericardium exerts constraint on the right ventricle during cardiac surgery.
abstract: The right ventricle may be particularly susceptible to the effects of pericardial constraint. This study examined the effects of pericardiotomy on right ventricular function. Twenty-four anesthetized patients with coronary artery disease, but without evidence of pericardial pathology, were studied. Anesthesia consisted of fentanyl (100 micrograms.kg-1), diazepam, pancuronium, and 100% oxygen. The American Edwards REF-1 Cardiac Output Computer, rapid-response thermistor pulmonary arterial catheter, and a radial arterial catheter were used to measure hemodynamic variables. Baseline measurements were obtained with the sternum fully retracted. The measurements were then repeated following pericardiotomy by a midline incision. There were significant (P less than 0.05) changes in systolic arterial pressure (+4.5%), mean arterial pressure (+3.7%), systolic pulmonary arterial pressure (+11.8%), cardiac output (+9.1%), stroke volume (+6.9%), right ventricular end-diastolic volume (+7.6%), and right atrial pressure (-8.6%). In the current study, pericardiotomy augmented right ventricular diastolic filling and stroke volume, while the right atrial pressure decreased. These results support the concept of pericardial constraint.
authors: Department of Anesthesiology, Mount Sinai Medical Center, New York.
authors: D L
authors: DL
authors: Reich
authors: S N
authors: SN
authors: Konstadt
authors: D M
authors: DM
authors: Thys
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D010492:Pericardiectomy; D010496:Pericardium / Q000502:physiology*; D016278:Ventricular Function, Right / Q000502:physiology*