Cardiac exercise hemodynamics late after partial left ventriculectomy

• Published in: Circulation (New York, N.Y.) Vol. 102; no. 19; pp. 200 - 203
• Main Authors: JAMES, Karen B, HAAS, Garrie, LUTTON, Suzanne R, PRIOR, David, WOLSKI, Kathy, BUDA, Tiffany, MCCARTHY, Patrick M
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 07-11-2000; American Heart Association, Inc
• Subjects: Biological and medical sciences; Blood Gas Analysis; Blood Pressure; Echocardiography; Exercise; Exercise Test; Female; Heart Function Tests; Heart Ventricles - diagnostic imaging; Heart Ventricles - physiopathology; Heart Ventricles - surgery; Hemodynamics; Humans; Male; Medical sciences; Middle Aged; Pulmonary Artery - physiopathology; Pulmonary Wedge Pressure; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Vascular Resistance; Human; Prognosis; Treatment; Partial; Surgery; Bicycle ergometer; Surgical resection; Hemodynamics; Left ventricle
• ISSN: 0009-7322; 1524-4539; 1524-4539
• DOI: 10.1161/01.cir.102.suppl_3.iii-200

Although some patients report favorable activity levels late after partial left ventriculectomy (PLV), their exercise physiology has not been well described.
We performed upright bicycle hemodynamics in 10 patients (9 men) aged 56+/-12 years at 1.7 years after PLV. Ejection fraction was 25+/-4%. Patients biked 10+/-7 minutes. With exercise, the mean pulmonary arterial pressure rose from 36+/-12 to 52+/-10 mm Hg (P:=0.0003). The mean pulmonary capillary wedge pressure rose from 25+/-14 to 36+/-9 mm Hg (P:=0.0566), and the cardiac index rose from 2.2+/-0.5 to 3.8+/-1.6 L. min(-1). m(-2) (P:=0.0077). The mixed venous oxygenation with exercise declined from 44+/-9% to 24+/-17% (P:=0. 0220), and the pulmonary vascular resistance increased from 2.0+/-0. 9 to 2.3+/-1.1 Wood units (P:=0.5566).
In late follow-up after PLV with exercise, the cardiac index is significantly augmented. However, there are further rises in pulmonary artery and pulmonary capillary wedge pressures, suggesting abnormal compliance, with marked decline in mixed venous oxygenation. Elucidating late physiology after PLV may help pave the way for future innovative heart failure surgeries.