Document Detail


The "jaundiced heart": a possible explanation for postoperative shock in obstructive jaundice.
MedLine Citation:
PMID:  3726756     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Patients with obstructive jaundice are susceptible to postoperative shock and kidney failure. The cause of these potentially fatal complications has not been fully clarified. The present study was designed to assess the role of myocardial dysfunction in the hemodynamic disturbance of obstructive jaundice. We studied the effect of isolated cholemia on left ventricular performance in five conscious dogs before and 2 weeks after choledochocaval anastomosis by using measurements of systolic time intervals (STIs) and maximal dp/dt. Mean left ventricular ejection tiem (LVET) decreased after cholemia from 159 +/- 2.8 msec to 139 +/- 2.6 msec (p less than 0.005), while mean preejection period (PEP) and mean PEP/LVET were increased from 41 +/- 8.5 msec to 87 +/- 14 msec (p less than 0.05) and from 0.39 +/- 0.06 to 0.62 +/- 0.1 (p less than 0.01), respectively. During cholemia, STIs were unchanged after intravenous administration of ouabain, whereas in the control period, there was shortening of mean PEP from 71 +/- 8.8 msec to 58 +/- 7.6 msec (p less than 0.05) and of Q-S2 from 257 +/- 12 msec to 235 +/- 14 msec (p less than 0.005) in response to ouabain. Maximal dp/dt decreased after choledochocaval anastomosis from 4543 +/- 593 mm Hg/sec to 3666 +/- 648 mm Hg/sec (p less than 0.025). We conclude that cholemia in the dog is clearly associated with impaired left ventricular performance. The present data also support a previously published in vitro study from our laboratory showing that cholemia blunts the myocardial contractile response to sympathomimetic agents. The cardiodepressor effect of cholemia may explain the increased tendency of patients with obstructive jaundice to postoperative shock and renal failure.
Authors:
J Green; R Beyar; S Sideman; D Mordechovitz; O S Better
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Surgery     Volume:  100     ISSN:  0039-6060     ISO Abbreviation:  Surgery     Publication Date:  1986 Jul 
Date Detail:
Created Date:  1986-08-05     Completed Date:  1986-08-05     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0417347     Medline TA:  Surgery     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  14-20     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Animals
Arteriovenous Shunt, Surgical
Bile Pigments / blood
Cholestasis / complications,  physiopathology*,  surgery
Common Bile Duct / surgery
Dogs
Heart / physiopathology*
Hypotension / etiology
Liver / physiopathology*
Liver Diseases / complications
Male
Shock / etiology,  physiopathology*
Stroke Volume
Systole
Venae Cavae / surgery
Chemical
Reg. No./Substance:
0/Bile Pigments

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


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