title: Volume expansion increases right ventricular infarct size in dogs by reducing collateral perfusion.
abstract: OBJECTIVE
  Plasma volume expansion is frequently recommended to correct the low output state resulting from right ventricular (RV) infarction. However, any subsequent increase in pericardial and RV filling pressures from volume expansion could impair RV collateral blood flow. We examined whether volume expansion in dogs before right coronary ligation reduced collateral perfusion and worsened the extent of RV necrosis.
  
  
  METHODS
  Randomized experimental study.
  
  
  METHODS
  Animal research laboratory in university medical center.
  
  
  METHODS
  Forty anesthetized, closed-chest dogs were randomly assigned to normovolemic, pericardium opened (n = 10) or intact (n = 10) groups, and hypervolemic, pericardium opened (n = 10) or intact (n = 10) groups.
  
  
  METHODS
  Hypervolemic animals received 24 mL/kg of 6% hetastarch. All animals underwent 90 min right coronary ligation, followed by 120 min reperfusion. Collateral coronary blood flow (radioactive microspheres) and area of necrosis (An) were determined in the area at risk (Ar).
  
  
  RESULTS
  Stroke volume decreased in all groups with ischemia but remained 25 to 40% greater in both hypervolemic groups than in normovolemic animals (p < 0.05). In hypervolemic animals with intact pericardium, RV end-diastolic pressure increased to 10.4 +/- 2.1 mm Hg (mean +/- SD), a value that significantly exceeded those of the other three groups. During RV ischemia, collateral perfusion in the Ar was similar in both normovolemic groups and in hypervolemic animals with opened pericardium (mean range, 12.9 +/- 8.8 to 13.8 +/- 7.6 mL/min/100 g; p = NS), and the An/Ar varied from 11.8 +/- 6.3 to 18.6 +/- 17.4% (p = NS). In contrast, in hypervolemic animals with intact pericardium, collateral perfusion decreased to 7.2 +/- 3.5 mL/min/100 g and the An/Ar was increased to 38.2 +/- 18.6% (p < 0.05 compared with other groups, respectively). Overall, An/Ar was inversely related to collateral blood flow in the Ar (r = -0.46; p < 0.05) and correlated positively with RV end-diastolic pressure (r = 0.61; p < 0.05).
  
  
  CONCLUSIONS
  Volume expansion preserved stroke volume during RV ischemia, independent of pericardial integrity. However, volume expansion in animals with an intact pericardium increased RV infarct size by twofold to threefold secondary to reduced periischemic collateral perfusion. This detrimental effect of volume expansion on infarct size was prevented by opening the pericardium.
authors.affiliation: Department of Anesthesiology, University of Texas Medical Branch, Galveston 77555-0591, USA.
authors.forename: W E
authors.initials: WE
authors.lastname: Johnston
authors.forename: C Y
authors.initials: CY
authors.lastname: Lin
authors.forename: A E
authors.initials: AE
authors.lastname: Feerick
authors.forename: B
authors.initials: B
authors.lastname: Spray
authors.forename: J
authors.initials: J
authors.lastname: Vinten-Johansen
mesh_terms: D000818:Animals; D002302:Cardiac Output; D003097:Collateral Circulation; D003326:Coronary Circulation; D004285:Dogs; D009203:Myocardial Infarction / Q000503:physiopathology*; D010953:Plasma Volume; D012039:Regional Blood Flow; D013318:Stroke Volume