title: The dicrotic pulse: a common, non-ominous finding after the Ross operation.
abstract: We noted a dicrotic pulse in several patients following a Ross operation. Although the etiology of this unique arterial waveform is not completely understood, it has been reported as a sign of low cardiac output and a poor prognosis. We reviewed preoperative echocardiograms and postoperative radial arterial pressure tracings in 33 patients who underwent a Ross procedure between 2000 and 2004. We found a dicrotic pulse to occur commonly (20/33; 61%) following a Ross operation. Moderate to severe preoperative aortic insufficiency was present in 19/20 patients (95%) in whom a dicrotic pulse was noted and in only 3/13 (23%) who did not exhibit a postoperative dicrotic pulse (p<0.001). A dicrotic pulse was not associated with an increased use of vasoactive infusions or longer hospitalization following the Ross operation. The dicrotic pulse should be recognized as a common postoperative finding in Ross patients that does not herald a delayed postoperative convalescence. The mechanism for a dicrotic pulse in these patients is speculative but may result from changes in vascular compliance secondary to chronic aortic insufficiency.
authors.affiliation: Oregon Health & Science University, Portland, OR, USA. barberb@peds.arizona.edu
authors.forename: B J
authors.initials: BJ
authors.lastname: Barber
authors.forename: R L
authors.initials: RL
authors.lastname: Donnerstein
authors.forename: T W
authors.initials: TW
authors.lastname: Secomb
authors.forename: K
authors.initials: K
authors.lastname: Pogreba-Brown
authors.forename: R
authors.initials: R
authors.lastname: Steelman
authors.forename: M S
authors.initials: MS
authors.lastname: Ellenby
authors.forename: I
authors.initials: I
authors.lastname: Shen
authors.forename: R M
authors.initials: RM
authors.lastname: Ungerleider
mesh_terms: D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures; D004562:Electrocardiography; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery; D006801:Humans; D008297:Male; D010149:Postoperative Pain; D011674:Pulse; D012189:Retrospective Studies