Improved cardiac function in patients with obstructive jaundice after internal biliary drainage: hemodynamic and hormonal assessment.
OBJECTIVE
To investigate myocardial function in patients with obstructive jaundice before and after internal biliary drainage.


BACKGROUND
Increased plasma levels of atrial natriuretic peptide (ANP) have been found in patients with biliary obstruction.


METHODS
Thirteen patients with newly diagnosed obstructive jaundice and no previous heart, lung, or renal disease were studied using a Swan-Ganz catheter. Hemodynamic measurements were taken before and 4 days after internal biliary drainage. Levels of ANP and brain natriuretic peptide (BNP) were obtained and liver function tests were also determined.


RESULTS
Plasma levels of ANP and BNP were increased twofold to fourfold in the basal state and declined after biliary drainage. Independent variables predicting left ventricular systolic work were total bilirubin concentrations, duration of jaundice, and BNP. In addition, bilirubin concentrations correlated with pulmonary vascular resistance, mean arterial pulmonary pressure, and right ventricular systolic work. Internal biliary drainage resulted in an improvement in left ventricular systolic work. A correlation was found between decreasing ANP concentrations and increasing cardiac output.


CONCLUSIONS
Increased plasma levels of natriuretic peptides in patients with obstructive jaundice may reflect a subclinical myocardial dysfunction correlating with the degree of jaundice. After internal biliary drainage, there is a measurable improvement of cardiac function.
Padillo
J
J
Department of Surgery, Hospital Universitario Reina Sofía, Córdoba, Spain.
Puente
J
J
Gómez
M
M
Dios
F
F
Naranjo
A
A
Vallejo
J A
JA
Miño
G
G
Pera
C
C
Sitges-Serra
A
A
D000328:Adult; D000368:Aged; D009320:Atrial Natriuretic Factor / Q000097:blood*; D001663:Bilirubin / Q000097:blood; D001794:Blood Pressure; D002302:Cardiac Output; D002779:Cholestasis / Q000378:metabolism / Q000503:physiopathology* / Q000601:surgery*; D004322:Drainage; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011651:Pulmonary Artery; D015607:Stents; D014655:Vascular Resistance; D016277:Ventricular Function, Left
D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor; D001663:Bilirubin