Effects of rapid paracentesis on right ventricular-arterial coupling in liver transplantation.
BACKGROUND
In cirrhotic patients intra-abdominal pressure (IAP) changes markedly modify splanchnic and systemic hemodynamics. Previous studies have evaluated the effects of increased IAP on steady-state cardiac performance, showing that right ventricular (RV) function becomes more depressed than that of the left ventricular. We sought to evaluate the effects of paracentesis on RV function and ventricular-arterial coupling among cirrhotics undergoing liver transplantation (OLT).


METHODS
Twelve cirrhotic patients undergoing OLT underwent hemodynamic profiles before and 5 minutes after paracentesis, employing a right ventricular ejection fraction catheter in the pulmonary artery. We studied heart rate, systolic pulmonary artery pressure, central venous pressure (CVP), stroke volume index (SVI), RV end-diastolic volume index (RVEDI), and RV ejection fraction. In addition RV stroke work index (RVSWI), RV end-diastolic compliance (RVEDC), RV end-systolic elastance (Ees), pulmonary artery effective elastance (Ea), and RV coupling efficiency (Ees/Ea ratio) were calculated employing standard formulas.


RESULTS
After removal of mean ascites volume of 5.6 +/- 2.2 L (range 4.0 to 8.04 L), SVI, RVEDI, RVSWI, and RVEDC were significantly increased and conversely CVP, Ees, and Ea were decreased with an ea/ea ratio unchanged.


CONCLUSIONS
Before paracentesis Ees/Ea is preserved by increased of RV contractility; after paracentesis the coupling was maintained.
Acosta
F
F
Liver Transplantation Unit, University Hospital V, Arrixaca, Murcia, Spain. franciscoj.acosta@carm.es
Sansano
T
T
Palenciano
C G
CG
Falcón
L
L
Doménech
P
P
Robles
R
R
Bueno
F S
FS
Ramírez
P
P
Parrilla
P
P
D001201:Ascites / Q000503:physiopathology; D001794:Blood Pressure; D003971:Diastole; D006339:Heart Rate; D006439:Hemodynamics; D006801:Humans; D008103:Liver Cirrhosis / Q000503:physiopathology / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods*; D019152:Paracentesis / Q000379:methods*; D013318:Stroke Volume; D016278:Ventricular Function, Right / Q000502:physiology*