Cardiac function during intraperitoneal CO2 insufflation for aortic surgery: a transesophageal echocardiographic study.
The effect of laparoscopy on cardiac function is controversial. We hypothesized that cardiac dysfunction related to increased afterload could be predominant in patients undergoing elective abdominal aortic repair. To test this hypothesis, we conducted a transesophageal echocardiographic study in 15 patients during laparoscopic aortic surgery. We systematically assessed left ventricular (LV) and right ventricular (RV) functions. Measurements were obtained in the supine position without pneumoperitoneum and with an intraabdominal pressure of 14 mm Hg. Then, patients were turned to the right lateral position without pneumoperitoneum and intraabdominal pressure was increased to 7 mm Hg and to 14 mm Hg. Pneumoperitoneum induced a 25% arterial blood pressure increase and a 38% increase in LV systolic wall stress. A 25% decrease in LV ejection fraction and an 18% decrease in LV stroke volume were observed, associated with an increase in LV end-systolic volume. LV diastolic function impairment was observed without change in LV end-diastolic volume. Respiratory alterations in superior vena cava diameter were never observed, suggesting that volume status remained optimal. Respiratory changes in RV stroke volume were increased according to intraabdominal pressure and body position, reflecting an increase in RV afterload. In conclusion, peritoneal CO2 insufflation in patients scheduled for laparoscopic aortic surgery could impair LV and RV systolic functions as a consequence of increased afterload.
Alfonsi
Pascal
P
Department of Anesthesiology, and Intensive Care Unit, Ambroise Paré University Hospital, Assistance Publique Hôpitaux de Paris, Boulogne, Cedex, France.
Vieillard-Baron
Antoine
A
Coggia
Marc
M
Guignard
Bruno
B
Goeau-Brissonniere
Olivier
O
Jardin
François
F
Chauvin
Marcel
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging* / Q000601:surgery*; D001794:Blood Pressure / Q000502:physiology; D002245:Carbon Dioxide; D002320:Cardiovascular Physiological Phenomena; D017548:Echocardiography, Transesophageal / Q000379:methods; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007327:Insufflation / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects / Q000379:methods*; D011446:Prospective Studies; D016277:Ventricular Function, Left / Q000502:physiology
D002245:Carbon Dioxide