Document Detail

Chronotropic and inotropic supports are both required to increase cardiac output early after corrective operations for tetralogy of Fallot.
MedLine Citation:
PMID:  2915564     Owner:  NLM     Status:  MEDLINE    
To assess the respective roles of chonotropism, inotropism, and afterload reduction in increasing cardiac index early after corrective operations for tetralogy of Fallot, we measured vascular pressures and cardiac output and evaluated left ventricular dimension changes before and after a 35% rise in heart rate over baseline. This rise was induced by atrial pacing with intact atrioventricular conduction, isoproterenol, or atrial pacing together with dobutamine. With atrial pacing, left ventricular end-diastolic diameter decreased (38.7 +/- 4.3 to 34.2 +/- 5.6 mm, p less than 0.05), the shortening fraction (ratio of the difference between left ventricular end-diastolic and end-systolic diameters to left ventricular end-diastolic diameter) remained constant, and stroke volume index was reduced (28.8 +/- 4.5 to 19.7 +/- 4.6 ml/m2, p less than 0.05). As a result, cardiac index was left unchanged. When dobutamine was added as supplemental inotropic support, left ventricular end-diastolic diameter remained constant, shortening fraction increased (30% +/- 5.4% to 36% +/- 3.3%, p less than 0.05), and cardiac index rose significantly (3.04 +/- 0.61 to 4.18 +/- 0.85 L/min/m2, p less than 0.05). Heart rate acceleration with isoproterenol, combining chronotropism, positive inotropic support, and afterload reduction, slightly increased left ventricular end-diastolic diameter, significantly raised shortening fraction, and markedly enhanced cardiac index (3.03 +/- 0.55 to 4.9 +/- 1.09 L/min/m2). Atrial pacing with intact atrioventricular conduction, as an isolated chronotropic stimulus, is not suited to increase cardiac index early after operations for tetralogy of Fallot unless additional inotropic support is simultaneously provided.
M Berner; I Oberhänsli; J C Rouge; C Jaccard; B Friedli
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  97     ISSN:  0022-5223     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  1989 Feb 
Date Detail:
Created Date:  1989-03-17     Completed Date:  1989-03-17     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  297-302     Citation Subset:  AIM; IM    
Department of Pediatrics and Genetics, Clinique Universitaire de Pédiatrie, Hôpital Cantonal, Geneva, Switzerland.
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MeSH Terms
Cardiac Output / drug effects
Cardiac Pacing, Artificial*
Child, Preschool
Combined Modality Therapy
Dobutamine / therapeutic use*
Heart Rate
Hemodynamics / drug effects*
Isoproterenol / therapeutic use*
Postoperative Care
Tetralogy of Fallot / surgery*
Vascular Resistance / drug effects
Reg. No./Substance:
34368-04-2/Dobutamine; 7683-59-2/Isoproterenol

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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