Left ventricular dysfunction during infrarenal abdominal aortic aneurysm repair.
BACKGROUND
Clinical observations suggest that pulmonary artery occlusion pressure (PAOP) underestimates the resuscitative volumes required prior to release of aortic cross-clamp.


METHODS
To investigate pressure-volume relationships associated with repair of abdominal aortic aneurysm (AAA), we simultaneously monitored PAOP by pulmonary artery catheter (PAC) and estimated left ventricular (LV) diastolic volume using two-dimensional transesophageal echocardiography (TEE) in 22 patients undergoing AAA repair. Data from PAC monitoring and TEE were collected before, during, and after aortic occlusion. TEE cross-sectional images were obtained at the mid-papillary level.


RESULTS
Overall, PAOP correlated with left ventricular end-diastolic area (LVEDA), but the correlation was not particularly strong (r = 0.37, P < 0.0001). Even within individual patients, LVEDA varied widely for a given PAOP. The strength of the correlation between PAOP and LVEDA also appeared to deteriorate during the course of surgery. The best correlation was seen prior to aortic cross-clamping (r = 0.50, P < 0.0001), but fell somewhat during aortic cross-clamping (r = 0.41, P < 0.0001), and even further after unclamping (r = 0.25, P = 0.005).


CONCLUSIONS
This study demonstrates a relatively weak correlation between PAOP and LVEDA using intraoperative TEE during AAA repair. Furthermore, the strength of the correlation worsened during surgery, particularly after unclamping. Although unclear at this time, this finding may be attributable to changes in LV compliance. We found TEE to be a valuable adjunct in guiding volume resuscitation of patients undergoing AAA repair.
Gillespie
D L
DL
Section of Vascular Surgery, Boston University Medical Center, Massachusetts 02118.
Connelly
G P
GP
Arkoff
H M
HM
Dempsey
A L
AL
Hilkert
R J
RJ
Menzoian
J O
JO
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000209:etiology / Q000503:physiopathology*; D001810:Blood Volume / Q000502:physiology; D003250:Constriction; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D007668:Kidney; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology*; D011292:Premedication; D011300:Preoperative Care; D011651:Pulmonary Artery / Q000503:physiopathology*; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D016277:Ventricular Function, Left / Q000502:physiology*