title: Exposure of circumflex branches in the tilted, beating porcine heart: echocardiographic evidence of right ventricular deformation and the effect of right or left heart bypass.
abstract: OBJECTIVE
  In off-pump coronary surgery, exposure of posterior vessels via sternotomy causes deterioration of cardiac function. Changes in ventricular geometry, valve competence, and hemodynamics after retraction of the beating heart were studied. Subsequently, the modifying effect of right or left heart bypass was investigated.
  
  
  METHODS
  In six 80-kg pigs, an ultrasound probe was attached to the backside of the left ventricle and the heart was fully retracted with a suction tissue stabilizer. Five pigs underwent additional pump support.
  
  
  RESULTS
  During retraction, the right ventricle was squeezed between the pericardium and interventricular septum, thereby decreasing its diastolic cross-sectional area by 62% +/- 6% (P <.001) while, concomitantly, right ventricular end-diastolic pressure increased to 165% +/- 19% (P =.004) of basal values. Stroke volume and mean arterial pressure decreased by 29% +/- 6% and 23% +/- 8% (P =.007 and P =.02, respectively). Left ventricular shape became somewhat elliptic without changes in preload pressure, and its diastolic cross-sectional area decreased by 20% +/- 3% (P =.001). All valves were competent. Right heart bypass restored left ventricular cross-sectional area, stroke volume, and mean arterial pressure. In contrast, left heart bypass increased blood pressure only marginally.
  
  
  CONCLUSIONS
  Ninety-degree anterior displacement of the beating porcine heart caused primarily right ventricular dysfunction as a result of mechanical interference with diastolic expansion without concurring valvular incompetence. Right heart bypass normalized stroke volume and mean arterial pressure by increasing left ventricular preload; in contrast, left heart bypass failed to restore systemic circulation.
authors.affiliation: Heart Lung Institute, Utrecht University Hospital, Utrecht, The Netherlands.
authors.forename: P F
authors.initials: PF
authors.lastname: Gründeman
authors.forename: C
authors.initials: C
authors.lastname: Borst
authors.forename: C W
authors.initials: CW
authors.lastname: Verlaan
authors.forename: H
authors.initials: H
authors.lastname: Meijburg
authors.forename: C M
authors.initials: CM
authors.lastname: Mouës
authors.forename: E W
authors.initials: EW
authors.lastname: Jansen
mesh_terms: D000818:Animals; D003331:Coronary Vessels / Q000601:surgery*; D004195:Disease Models, Animal; D004452:Echocardiography; D018611:Heart Bypass, Left / Q000009:adverse effects; D018610:Heart Bypass, Right / Q000009:adverse effects; D006351:Heart Valves / Q000000981:diagnostic imaging / Q000502:physiology; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D007431:Intraoperative Complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D009200:Myocardial Contraction; D009204:Myocardial Revascularization / Q000379:methods; D013318:Stroke Volume; D013552:Swine; D016276:Ventricular Function; D017725:Ventricular Pressure