Document Detail

Systemic venous flow during cardiac surgery examined by intraoperative transesophageal echocardiography.
MedLine Citation:
PMID:  1734654     Owner:  NLM     Status:  MEDLINE    
Patterns of systemic venous return change after cardiac surgery. However, the exact timing and underlying mechanisms are not well understood. To analyze these changes transesophageal echocardiography was used to evaluate 21 patients (mean age 56 +/- 17 years) during cardiac surgery. Eleven patients underwent coronary bypass grafting, 2 had ablation of accessory bundles, 4 had mitral and 4 had aortic valve replacements. All were in sinus rhythm and were undergoing their first cardiac operation. Hepatic and pulmonary venous flow, tricuspid annular motion, and signs of tricuspid regurgitation were recorded sequentially 5 times: (A) with chest closed, (B) with chest open and pericardium closed, (C) with both chest and pericardium open, (D) after cardiopulmonary bypass with chest open, and (E) after cardiopulmonary bypass with chest closed. The hepatic venous Doppler flow velocity integrals (cm) changed, from stage A to stage E: systolic flow decreased from 5.9 +/- 5.2 to 2.2 +/- 1.4 (p less than 0.01); diastolic flow increased from 3.1 +/- 1.5 to 4.8 +/- 3.3 (p less than 0.001); and systolic to diastolic ratio decreased from 2.0 +/- 1.2 to 0.7 +/- 0.6 (p less than 0.001). Reversed flow at the end of ventricular systole was present in 9 patients (43%) at stage A and in all patients at stage E. Decreased tricuspid annular motion was noted in all but 1 patient after cardiopulmonary bypass. No patient presented significant tricuspid regurgitation at any stage. In conclusion, the significant change in the pattern of systemic venous return after open heart surgery is not due to opening of the chest wall or parietal pericardium, or to tricuspid regurgitation.(ABSTRACT TRUNCATED AT 250 WORDS)
F J Pinto; B Wranne; F G St Goar; L C Siegel; G Haddow; I Schnittger; R L Popp
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  The American journal of cardiology     Volume:  69     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  1992 Feb 
Date Detail:
Created Date:  1992-03-02     Completed Date:  1992-03-02     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  387-93     Citation Subset:  AIM; IM    
Department of Anesthesia, Stanford University School of Medicine, California 94305.
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MeSH Terms
Aged, 80 and over
Analysis of Variance
Blood Flow Velocity
Cardiac Surgical Procedures*
Echocardiography, Doppler*
Hepatic Veins / physiopathology
Middle Aged
Monitoring, Intraoperative / methods
Pulmonary Veins / physiopathology
Regression Analysis
Tricuspid Valve / physiopathology
Veins / physiopathology*
Ventricular Function, Right

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