Analysis of diastolic function in patients undergoing aortic aneurysm repair and impact on hemodynamic response to aortic cross-clamping.
OBJECTIVE
The purpose of this study was to analyze left ventricular diastolic function in patients undergoing aortic aneurysm repair and to investigate the effects of laparotomy and aortic cross-clamping on diastolic function.


METHODS
Prospective clinical study.


METHODS
University hospital.


METHODS
Forty-five consecutive patients undergoing open aortic aneurysm repair.


METHODS
Left ventricular diastolic function and hemodynamic variables were evaluated using transesophageal Doppler echocardiography and a pulmonary artery catheter at baseline, after laparotomy, and at 1 and 10 minutes after cross-clamping. Diastolic function was determined by Doppler derivatives of mitral inflow (E/A ratio, deceleration time of early inflow) and pulmonary venous flow (S/D ratio).


RESULTS
Twenty of 39 patients revealed signs of diastolic dysfunction at baseline. Of these 20 patients, 14 displayed delayed relaxation and 6 displayed a pseudonormal filling pattern. Patients with pseudonormal filling exhibited a lower stroke volume (p = 0.02) and cardiac index (p < 0.01) in comparison to patients with normal diastolic function. Laparotomy was associated with an improvement of diastolic function in 9 of 20 patients with preexisting diastolic dysfunction. Only 3 patients suffered impairment of diastolic function after cross-clamping. The hemodynamic response to cross-clamping did not differ between patients with normal and abnormal diastolic function.


CONCLUSIONS
About 50% of patients undergoing aortic aneurysm repair exhibit signs of diastolic dysfunction. The majority of these patients showed delayed relaxation. Patients with pseudonormal filling displayed a significantly lower cardiac index. Laparotomy resulted in an improvement in diastolic function in about half of patients with preexisting diastolic dysfunction. The effects of cross-clamping on diastolic function are minimal.
Meierhenrich
Rainer
R
Department of Anesthesiology, University of Ulm, Ulm, Germany. rainer.meierhenrich@medizin.uni-ulm.de
Gauss
Albrecht
A
Anhaeupl
Thomas
T
Schütz
Wolfram
W
D000368:Aged; D000758:Anesthesia; D001011:Aorta / Q000502:physiology; D001014:Aortic Aneurysm / Q000601:surgery*; D002406:Catheterization, Peripheral; D003250:Constriction; D003971:Diastole; D004452:Echocardiography; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000502:physiology; D013318:Stroke Volume / Q000502:physiology; D014656:Vascular Surgical Procedures; D016277:Ventricular Function, Left / Q000502:physiology