Document Detail


Genuine effects of ventricular fibrillation upon myocardial blood flow, metabolism and catecholamines in patients with aortic stenosis.
MedLine Citation:
PMID:  15204237     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Ventricular fibrillation (VF) is life-threatening because of its haemodynamic and metabolic effects. The purpose was to examine if VF also has primary effects per se. We therefore investigated the early effects of VF on myocardial blood flow, metabolic characteristics and catecholamine concentrations in patients undergoing surgery for aortic stenosis. DESIGN: The immediate effects of up to 5 min of VF were studied in 21 patients during cardiopulmonary bypass (CPB) before valve replacement. RESULTS: During VF the global myocardial oxygen consumption, coronary blood flow and vascular resistance were unchanged, and the mean arterial pressure (on CPB) decreased from 70 to 51 mmHg (p < 0.02). Fibrillation induced a high myocardial tone and a probable functional aortic insufficiency, which instantly equilibrated left ventricular and aortic pressures. Signs of myocardial ischaemia and acidosis developed after 4 min: a decrease in the pH of coronary sinus blood from 7.38 to 7.32 (p < 0.001), an increased release of lactate from 32 to 137 micromol/min (p < 0.001) and potassium from 29 to 73 micromol/min (p < 0.05). The noradrenaline net release increased from 0.021 to 0.58 nmol/min (p < 0.02) after 1.5 min of VF and then decreased. The adrenaline net uptake remained low and unchanged (17-28%). CONCLUSION: VF in patients with aortic stenosis was rapidly followed by myocardial ischaemia, acidosis and a transient increase in the myocardial noradrenaline net release despite sufficient coronary perfusion and unchanged global myocardial oxygen consumption. The VF instantly induced equilibration of left ventricular and aortic pressure and probably caused a relative underperfusion of the subendocardium. These factors all support persistence of VF.
Authors:
Bengt Sandstedt; Johan Pontén; S Bertil Olsson; Nils Edvardsson
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Scandinavian cardiovascular journal : SCJ     Volume:  38     ISSN:  1401-7431     ISO Abbreviation:  Scand. Cardiovasc. J.     Publication Date:  2004 May 
Date Detail:
Created Date:  2004-06-18     Completed Date:  2004-09-07     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9708377     Medline TA:  Scand Cardiovasc J     Country:  Norway    
Other Details:
Languages:  eng     Pagination:  113-20     Citation Subset:  IM    
Affiliation:
Division of Cardiology, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden. bengt.sandstedt@swipnet.se
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Analysis of Variance
Aortic Valve Stenosis / surgery*,  ultrasonography
Blood Flow Velocity
Cardiopulmonary Bypass / adverse effects,  methods
Catecholamines / analysis,  metabolism*
Echocardiography, Doppler
Electrocardiography
Female
Follow-Up Studies
Heart Valve Prosthesis Implantation / adverse effects*,  methods
Humans
Intraoperative Complications / diagnosis*
Linear Models
Male
Middle Aged
Myocardial Ischemia / diagnosis*,  metabolism
Probability
Prospective Studies
Risk Assessment
Severity of Illness Index
Survival Rate
Treatment Outcome
Vascular Resistance / physiology
Ventricular Fibrillation / complications,  diagnosis*
Chemical
Reg. No./Substance:
0/Catecholamines

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