Single, Total Paracentesis for Tense Ascites: Sequential Hemodynamic Changes and Right Atrial Size

Abstract

Hemodynamic changes induced by a single, total paracentesis were evaluated in 21 patients with tense ascites from whom 4 to 16 L of ascites were drained over 2 to 8 hr with no serious complications. At 60 min, compared to baseline, there was an increase in cardiac output (7.7 ± 0.5 to 8.5 ± 0.6 L/min, p < 0.02) and a tendency for right atrial pressure to decrease (9.3 ± 0.8 to 7.50 ± 0.8 mm Hg, NS), with no change in pulmonary capillary wedge pressure (10.9 ± 0.9 to 10.7 ± 0.9 mm Hg). Between 3 and 12 hr later, there was a drop in right atrial pressure, pulmonary capillary wedge pressure and cardiac output to 5.6 ± 0.6 (p < 0.02), 7.2 ± 0.8 mm Hg (p < 0.002) and 7.2 ± 0.6 L/min (NS) respectively, indicative of the development of relative hypovolemia and suggesting that therapeutic plasma expansion is appropriate at this time. Two–dimensional echocardiography before paracentesis (n = 8) showed a reduction in the right to left atrium area ratio as compared with values in patients with minimal ascites (0.54 ± 0.04 vs. 0.82 ± 0.02, p < 0.0001). This technique may help in identifying patients with right atrial compression caused by tensea ascites.(HEPATOLOGY 1990; 11:662–667.)