title: Acute intraoperative effect of intravenous amiodarone on right ventricular function in patients undergoing valvular surgery.
abstract: BACKGROUND
  Amiodarone is commonly used in the acute care setting. However the acute hemodynamic and echocardiographic effect of intravenous amiodarone administered intraoperatively on right ventricular (RV) systolic and diastolic function using transesophageal echocardiography (TEE) has not been described.
  
  
  METHODS
  The study design was a randomized controlled trial in elective cardiac surgical patients undergoing valvular surgery. Patients received an intravenous loading dose of 300 mg of either amiodarone or placebo in the operating room, followed by an infusion of 15 mg/kg for two days. Hemodynamic profiles, echocardiographic measurement of RV and left ventricular (LV) dimensions, Doppler interrogation of tricuspid and mitral valve, hepatic and pulmonary venous flow combined with tissue Doppler imaging of the tricuspid and mitral valve annulus were obtained before and after bolus.
  
  
  RESULTS
  Although more patients in the placebo group had chronic obstructive lung disease (14 vs 6, p=0.05) and diabetes (14 vs 5; p=0.0244), there was no difference in terms of baseline hemodynamic, 2D and Doppler variables. After bolus, a significant increase in pulmonary artery pressure, central venous pressure and pulmonary vascular resistance index (p<0.05) was observed in the amiodarone group with reduction in systolic to diastolic (S/D) ratio of the hepatic (p=0.0247) and pulmonary venous (p=0.0052) velocity.
  
  
  CONCLUSIONS
  Acute administration of amiodarone is associated with alteration in RV diastolic properties and has minimal negative inotropic effect on RV systolic function in cardiac surgical patients with valvular disease.
authors.affiliation: Department of Anesthesiology, and Division of Critical Care, Montreal Heart Institute, Université de Montréal, Canada Division of Critical Care, Centre Hospitalier de l'Université de Montréal, Canada andre.denault@gmail.com.
authors.forename: André Y
authors.initials: AY
authors.lastname: Denault
authors.affiliation: Department of Medicine and Critical Care Division, Hôpital du Sacré-Coeur, Université de Montréal, Canada.
authors.forename: Yanick
authors.initials: Y
authors.lastname: Beaulieu
authors.affiliation: Department of Anesthesiology, and Division of Critical Care, Montreal Heart Institute, Université de Montréal, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Couture
authors.affiliation: Stanford Division of Cardiovascular Medicine, Stanford University School of Medicine, USA.
authors.forename: Francois
authors.initials: F
authors.lastname: Haddad
authors.affiliation: Department of Medicine, Montreal Heart Institute and Université de Montréal, Canada.
authors.forename: Yanfen
authors.initials: Y
authors.lastname: Shi
authors.affiliation: Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Pagé
authors.affiliation: Montreal Heart Institute Coordinating Center, Canada.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Levesque
authors.affiliation: Department of Medicine, Montreal Heart Institute and Université de Montréal, Canada.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Tardif
authors.affiliation: Department of Preventive and Social Medicine, Université de Montréal, Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Lambert
mesh_terms: D061605:Administration, Intravenous; D000638:Amiodarone / Q000008:administration & dosage* / Q000494:pharmacology; D004311:Double-Blind Method; D015150:Echocardiography, Doppler; D017548:Echocardiography, Transesophageal; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D006439:Hemodynamics / Q000187:drug effects; D006503:Hepatic Veins / Q000000981:diagnostic imaging* / Q000187:drug effects; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000187:drug effects; D011667:Pulmonary Veins / Q000000981:diagnostic imaging* / Q000187:drug effects; D014261:Tricuspid Valve / Q000000981:diagnostic imaging* / Q000187:drug effects; D016278:Ventricular Function, Right / Q000187:drug effects*
chemical_list: D000638:Amiodarone
keywords: Amiodarone; Doppler; hemodynamic monitoring; left ventricular function; right ventricular function; transesophageal echocardiography