The effects of the pericardium on length-dependent regulation of left ventricular function in coronary artery surgery patients.
OBJECTIVE
To analyze the effects of the pericardium on the length-dependent regulation of myocardial function in coronary artery surgery patients.


METHODS
Prospective.


METHODS
University hospital.


METHODS
Patients scheduled for elective coronary artery surgery.


METHODS
In 10 patients, a combined micromanometer transducer conductance catheter was inserted into the left ventricle for measurement of left ventricular pressures and volumes.


RESULTS
Consecutive data were obtained during a progressive increase in left ventricular pressures and volumes obtained by leg elevation in closed chest-closed pericardium and open chest-open pericardium conditions. Pericardiotomy did not alter baseline left ventricular hemodynamics. The effects of leg elevation were different, however. In closed chest-closed pericardium conditions, stroke volume and stroke work remained unchanged, whereas these parameters increased in open chest-open pericardium conditions. This increase was related to the increase in end-diastolic volume that was observed in open chest-open pericardium conditions and not in closed chest-closed pericardium conditions.


CONCLUSIONS
In coronary artery surgery patients, pericardiotomy does not alter baseline left ventricular function. When cardiac load is increased by leg elevation, however, use of the Frank-Starling mechanism is enhanced in open chest-open pericardium conditions.
De Hert
S G
SG
Departments of Anesthesiology and Cardiac Surgery, University Hospital Antwerp, Edegem, Belgium.
ten Broecke
P W
PW
Rodrigus
I E
IE
Mertens
E
E
Stockman
B A
BA
Vermeyen
K M
KM
D003331:Coronary Vessels / Q000601:surgery*; D006339:Heart Rate / Q000502:physiology; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007866:Leg / Q000098:blood supply; D008365:Manometry; D009200:Myocardial Contraction / Q000502:physiology; D010496:Pericardium / Q000502:physiology*; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000502:physiology; D013318:Stroke Volume / Q000502:physiology; D014656:Vascular Surgical Procedures; D016277:Ventricular Function, Left / Q000502:physiology*