Hemodynamic Effects of Portal Triad Clamping With and Without Pneumoperitoneum: An Echocardiographic Study
- 1 March 2005
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Anesthesia & Analgesia
- Vol. 100 (3), 617-622
- https://doi.org/10.1213/01.ane.0000144592.20499.12
Abstract
The decrease of cardiac index observed during portal triad clamping (PTC) with and without pneumoperitoneum has been studied only with right heart catheterization. To better understand this decrease of cardiac index, we investigated the balance between the adequacy of preload and the ability of the heart to pump against an increased afterload, by using transesophageal echocardiography. Ten patients with PTC performed during laparoscopy and 10 with PTC performed during laparotomy were studied. Five minutes after PTC, the stroke volume, the left ventricular (LV) fractional area change (FAC), and the LV end-systolic wall stress (LVESWS) were measured as the conventional hemodynamic variables. Regional wall motion abnormalities (RWMA) were also recorded. In the laparotomy group, LV end-diastolic area decreased, and LVESWS did not increase significantly. FAC remained stable, and one patient developed RWMA. In the laparoscopic group, LV end-diastolic area remained stable, and LVESWS increased. FAC decreased significantly, and five patients developed RWMA. A decrease in preload was the main important change in the laparotomy group, and in the laparoscopic group a decrease in LV function was demonstrated that was likely a consequence of decreased LV preload and increased LV afterload. However, these did not necessitate stopping the procedure or releasing PTC in these study patients without cardiac disease.Keywords
This publication has 21 references indexed in Scilit:
- Laparoscopic liver resectionBritish Journal of Surgery, 2003
- Laparoscopic Liver Resections: A Feasibility Study in 30 PatientsAnnals of Surgery, 2000
- Intraperitoneal and Retroperitoneal Carbon Dioxide Insufflation Evoke Different Effects on Caval Vein Pressure Gradients in HumansAnesthesiology, 2000
- Cardiovascular consequences of laparoscopic surgeryThe Lancet, 1998
- Left Ventricular Loading Modifications Induced by PneumoperitoneumAnesthesia & Analgesia, 1998
- Acute Hypovolemia May Cause Segmental Wall Motion Abnormalities in the Absence of Myocardial IschemiaAnesthesia & Analgesia, 1997
- Altered Load Dependence of Postischemic MyocardiumAnesthesiology, 1991
- Acute Ventricular Wall Motion HeterogeneityAnesthesiology, 1991
- Superiority of two-dimensional measurement of aortic vessel diameter in doppler echocardiographic estimates of left ventricular stroke volumeJournal of the American College of Cardiology, 1985
- Wall stress and patterns of hypertrophy in the human left ventricle.JCI Insight, 1975