Acute elevation of coronary venous pressure does not affect left ventricular contractility in the normal and stressed swine heart: Implications for the Fontan operation

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 114; no. 4; pp. 560 - 567
• Main Authors: Klautz, Robert J.M., van Rijk-Zwikker, Gerda L., Steendijk, Paul, Wilde, Jim, Teitel, David F., Baan, Jan
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Mosby, Inc 01-10-1997; AATS/WTSA; Elsevier
• Subjects: Adrenergic beta-Agonists - pharmacology; Animals; Biological and medical sciences; Cardiopulmonary Bypass; Coronary Circulation - physiology; Coronary Vessels - physiology; Dobutamine - pharmacology; Fontan Procedure; Intraoperative Care; Medical sciences; Myocardial Contraction - physiology; Postoperative Care; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Swine; Venous Pressure; Ventricular Function, Left - drug effects; Ventricular Function, Left - physiology; Ventricular Pressure - physiology; Coronary vein; Contractility; Increase; Experimental study; Fontan operation; Pressure; Left ventricle; Vertebrata; Mammalia; Swine; Surgery; Animal; Artiodactyla; Hemodynamics; Ungulata
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/S0022-5223(97)70045-X

Objective: After the Fontan operation the right atrium and, thus, the coronary sinus are connected to the pulmonary arterial system, which causes the coronary venous pressure to increase. We investigated the acute effects of elevation of coronary venous pressure on baseline hemodynamics, coronary venous flow, and left ventricular contractility.
Methods: In acutely instrumented pigs, during complete right heart bypass and during constant cardiac output, pressure in the right atrium, right ventricle, and coronary sinus was altered by a height-adjustable reservoir. At various levels of coronary venous pressure (up to 4 kPa or up to 30 mm Hg), flow from the reservoir was measured and left ventricular hemodynamics and contractility were measured from catheter-derived left ventricular pressure and (conductance) volume data. Contractility of the left ventricle was assessed by the end-systolic pressure-volume relationship derived during an unloading intervention by adjusting the bypass pump speed.
Results: Left ventricular end-diastolic pressure increased slightly (about 5%) with each kilopascal increase in coronary venous pressure, most likely related to diastolic ventricular interaction. No other changes in hemodynamic parameters occurred. Neither coronary venous flow nor left ventricular contractility was influenced by changes in coronary venous pressure. Imposing myocardial stress with dobutamine, 10 μg/kg per minute, did not change these findings.
Conclusion: Increasing coronary venous pressure to 4 kPa in the intact circulation with intact autoregulation does not affect coronary flow or left ventricular contractility. We found no experimental evidence for the usefulness of diversion of the coronary sinus to the left atrium during Fontan-type operations. (J Thorac Cardiovasc Surg 1997;114:560-7)