OBJECTIVETo observe the hemodynamic changes in patients undergoing pericardiectomy at different operational stages.

METHODSTotally 16 consecutive patients receiving radical pericardiectomy were enrolled in this observational study. Hemodynamic variables were monitored continuously by pulse-indicated continuous cardiac output(PiCCO)system. Totally,three sets of intraoperative hemodynamic parameters were obtained at three different stages of pericardiectomy.

RESULTSDuring the pericardiectomy,the cardiac index[CI,(1.9±0.6),(2.7±0.6),(3.0±0.5)L·min(-1)·m(-2);P<0.05]and stroke volume index[SI,(22.5±8.7),(29.9±8.5),(30.1±8.5)dyn·s·cm(-5)·m(2);P<0.05]showed significant improvement,whereas central venous pressure[CVP,(17.1±5.0),(13.3±3.9),(12.3±3.0)mmHg;P<0.05]decreased significantly. Global end-diastolic volume index[GEDVi,(533±156),(580±153),(559±144)ml·m(-2);P<0.05]increased and stroke volume variation[SVV,(15.6±6.1)%,(10.8±4.2)%,(9.4±5.4)%;P<0.05]decreased intra-operatively. The majority of the above-mentioned hemodynamic improvements occurred after the resection of pericardium over the left ventricular outflow tract(LVOT).

CONCLUSIONSPiCCO system can serve as a reliable,less invasive hemodynamic monitoring method during pericardiectomy. Resection of the pericardium over the LVOT is the most important step of the pericardiectomy.

Simultaneous intraoperative measurements of eardiac output were obtained in twenty one patients with thoracic electric bioimpedance(TEB) and transesophageal Doppler, two patients with transesophageal Doppler and thermodilution, one patient with TEB and thermodilution, and three patients with TEB, transesophageal Doppler and thermodilution techniques to evaluate the utility of noninvasive methods. Pairs of measurments were obtained 6S times with TEB and thermodilution, 109 times with transesophageal Doppler and thermodilution, and 373 times with TEB and transesophageal Doppler techniques. Correlation of the measurements was poor, with r=0.39 for TEB and thermodilution, r=0.44 for transesophageal Doppler and thermodilution, and r=0.39 for TEB and transesophageal Doppler. The mean difference between TEB and thermodilution, transesophageal Doppler and thermodilution, and TEB and transesophageal Doppler values was -2.41+/-1.79 L/min(mean+/-SD), -0.98+/-1.70 L/min, and -0.69+/-1.01 L/min, respectively. The scattergrams with confidence band lines showed that 22.0% of the scattergram points fell within +/-20% band and 51.5% within +/-40% band in TEB and thermodilution, 55.0% of the scattergram points fell within +/-20% band and 77.9% within +/-40% band in transesophageal Doppler and thermodilution, and 63.6% of the scattergram points fell within +/-20% band and 90.9 within +/-40% band in TEB and transesophageal Doppler. Therefore, it is concluded that neither noninvasive technique reliably estimated cardiac output as determined by thermodilution.
Cardiac Output* ; Humans ; Thermodilution*

No abstract available.
Cardiac Output* ; Ultrasonography*

The cardiac output and hemodynamic indices were measured by the bioimpedance method using NCCOM3 in 38 selected spinal anesthetic cases with 0.5% bupivacain. The authors observed MAP, HR, PFI, EDI, CI and SI changes before-and during spinal anesthesia. The results were as follows: The mean values for MAP before, 10 minutes and 30 minutes after spinal anesthesia were observed to be 96.18+/-14.25 and 9.45+/-14.89 mmHg. These values during spinal anesthesia were significantly decreased compared with the value before spinal anesthesia(P<0.01). The mean values for HR before, and 30 minutes after spinal anesthesia were observed to be 71.34+/-17.25 and 72.39+/-19,01 beat/min. The value during spinal anesthesia was significantly decreased compared with the value before spinal anesthesia(P<0.01). The mean value for PFI before and during spinal anesthesia were observed to be 306.55+/-75.63 and 285.47+/-73.60 1/sec/m2 . The value duing spinal anesthesia was insignificantly decreased compared with the value before spinal anesthesia.(P<0.05). The changes of mean values of EF, EDI and SI were insignificant statistically. The mean values for CI before and 30 minutes after spinal anesthesia were observed to be 3.49+/-1.02 and 3.11+/-0.86(1/min/m2) The value during spinal anesthesia was significantly decreased compared with the value before spinal Anesthesia(P<0.01)
Anesthesia, Spinal* ; Cardiac Output ; Hemodynamics*

> BACKGROUND: The accuracy of flow-related changes in aortic valve area (AVA) determined by the Gorlin formula or the continuity equation remains disputable. However, anatomic AVA can be determined by using by direct planimetry of transesophageal echocardiography (TEE). The purpose of this study was to assess the impact of changes in flow on AVA determined by TEE using direct planimetry. METHOD: Determination of AVA by TEE using direct planimetey was performed intraoperatively under three different hemodynamic conditions - pre-dobutamine (baseline) period, post-dobutamine period, post-CABG period - in 17 CABG patients and cardiac output (CO) with left ventricular ejection fraction (EF) were also determined by TEE simutaneously. The changes in aortic flow were induced by dobutamine infusion. RESULTS: AVA at pre-dobumaine period, post-dobutamine period, and post-CABG period were 2.99+/-0.80 cm2, 3.01+/-0.79 cm2, and 3.01+/-0.80 cm2, respectively. Before dobutamin infusion, CO and EF were 2.01+/-0.64 L/min and 47+/-10%. After dobutamine infusion, CO and EF were 3.03+/-1.05 L/min, 54+/-9% respectively and significantly increased by 54%, 18% than those measured before dobutamine infusion (p<0.01, p<0.01), respectively. After CABG, CO and EF were 3.86+/-1.86 L/min and 58+/-11% and also significantly increased by 98%, 26% than those measured before dobutamine infusion (p<0.01, p<0.01), respectively. However, despite of these significant hemodynamic changes, there were no significant changes in AVA and no significant correlations between these hemodynamic and AVA changes, neither at post-dobutamine period nor post-CABG period. CONCLUSION: The acute changes in CO and EF do not result in significant alterations in the anatomic AVA determined by TEE using direct planimetry. Thus, TEE using direct planimetry could be accurate and useful in the determination of AVA in hemodynamically unstable patient.
Aortic Valve* ; Cardiac Output* ; Dobutamine ; Echocardiography, Transesophageal* ; Hemodynamics ; Humans ; Stroke Volume*

> BACKGROUND: The accuracy of flow-related changes in aortic valve area (AVA) determined by the Gorlin formula or the continuity equation remains disputable. However, anatomic AVA can be determined by using by direct planimetry of transesophageal echocardiography (TEE). The purpose of this study was to assess the impact of changes in flow on AVA determined by TEE using direct planimetry. METHOD: Determination of AVA by TEE using direct planimetey was performed intraoperatively under three different hemodynamic conditions - pre-dobutamine (baseline) period, post-dobutamine period, post-CABG period - in 17 CABG patients and cardiac output (CO) with left ventricular ejection fraction (EF) were also determined by TEE simutaneously. The changes in aortic flow were induced by dobutamine infusion. RESULTS: AVA at pre-dobumaine period, post-dobutamine period, and post-CABG period were 2.99+/-0.80 cm2, 3.01+/-0.79 cm2, and 3.01+/-0.80 cm2, respectively. Before dobutamin infusion, CO and EF were 2.01+/-0.64 L/min and 47+/-10%. After dobutamine infusion, CO and EF were 3.03+/-1.05 L/min, 54+/-9% respectively and significantly increased by 54%, 18% than those measured before dobutamine infusion (p<0.01, p<0.01), respectively. After CABG, CO and EF were 3.86+/-1.86 L/min and 58+/-11% and also significantly increased by 98%, 26% than those measured before dobutamine infusion (p<0.01, p<0.01), respectively. However, despite of these significant hemodynamic changes, there were no significant changes in AVA and no significant correlations between these hemodynamic and AVA changes, neither at post-dobutamine period nor post-CABG period. CONCLUSION: The acute changes in CO and EF do not result in significant alterations in the anatomic AVA determined by TEE using direct planimetry. Thus, TEE using direct planimetry could be accurate and useful in the determination of AVA in hemodynamically unstable patient.
Aortic Valve* ; Cardiac Output* ; Dobutamine ; Echocardiography, Transesophageal* ; Hemodynamics ; Humans ; Stroke Volume*

The purpose of this study is to investigate changes of the cardiac output and the cardiac muscle contractility during postural gradient changes in man. Subjects consisted of 15 healthy males that they were aged 23-24 years. The Cardiac output and the contractility were calculated using the impedance cardiogram that were recorded by new apparatus developed in Yonsei Medical Center. The impedance cardiogram was recorded in different 7 gradients which were 0degrees, +/-2degrees, +/- 45degrees and +/-90degrees according to the head position, but it was continuously recorded at each gradient. The each postural gradient was changed after supine resting, 15-20 min, and continued in 5 min. Results of this study were following, 1. The cardiac output was decreased at head up posture (+2degrees, +45degrees and +90degrees) because of decreasing stroke volume. But the cardiac output was increased at head down posture (-2degrees, -45degrees and -90degrees) by increasing stroke volume. 2. The cardiac output was significantly changed at +/-45degrees and +/-90degrees after immediately gradient changes, but it was no significant difference at 0 and +/-2degrees postures from that of supine resting state. 3. At +/-45degrees and +/-90degrees, the cardiac muscle contractility was increased, and in head up posture, amounts of change were more larger than in head down posture.
Cardiac Output* ; Cardiography, Impedance ; Electric Impedance ; Head ; Humans ; Male ; Myocardium* ; Posture ; Stroke Volume

Hemodynamics in 60 normal, 15 simple goiter and 40 hyperthyroid subjects were determined from non-invasive Wezler's method. Hemodynamic changes in hyperthyroid patients were compared with those of normal subjects. The relationships of the cardiac output, aging,131I uptake rate and PEP/LVET to the hemodynamic changes in Hyperthyroid patients were also discussed. 1) The hemodynamics of normal subjects were same as those of simple goiter. 2) The heart rate and cardiac output were increased very significantly in hyperthyroid patients but they appeared to decrease with age. The stroke volume was increased slightly in the hyperthyroid patients, but remained unlateerd even with aging. Peripheral arterial resistance in hyperthyroid patients was decreased but appeared to increase with age. 3) As the131I uptake rate increased, the heart rate, cardiac output also increased, but PEP/LVET as an index of myocardial contractility and the peripheral arterial resistance decreased. 4) PEP/LVET as an index of myocardial contractility in hyperthyroid patients was markedly reduced. 5) The relationship of stroke volume and the rate of the heart to cardiac output in normal subjects were reasonably linear, and peripheral arterial resistance has negative relation to cardiac output. However the heart rate, though increased in most patients with thyrotoxicosis, bears no close relations to the level of cardiac output increment. The relationshop of stroke volume to cardiac output in hyperthyroid patients is reasonably linear and peripheral arterial resistance has negative correlation with the cardiac output.
Aging ; Cardiac Output ; Goiter ; Heart ; Heart Rate ; Hemodynamics* ; Humans ; Stroke Volume ; Thyrotoxicosis

BACKGROUND: The 3 minutes increment of dobutamine dose protocol is most commonly used method in dobutamine stress echocardiography (DSE). But the precise hemodynamic response to dobutamine dosage and its difference by extending stage duration have not been well elucidated. MATERIALS AND METHOD: Nineteen healthy voluntary subjects with a mean age of 23.9+/-4.7 years were included. All subjects underwent 3-minutes incremental and 5-minnutes incremental protocol of DSE at random order in a same day. Heart rate, blood pressure, stroke volume, fractional shortening, rate-pressure product and cardiac output were measured every 3 minutes in 3-min protocol of DSE. In 5-min protocol, same variables were measured at 3 minutes of each stage as well as at 5 minutes. RESULTS: 1) Heart rate did not increase until 10 microgram/kg/min dose and increased thereafter by increment of dobutamine dose. 2) Fractional shortening and stroke volume increased markedly from the 5 microgram/kg/min until 20 microgram/kg/min dose and showed slow increase or plateau at a higher dobutamine dose. 3) Systolic blood pressure, cardiac output and rate-pressure product increased continuously from initial dose to maximal dose. 4) Although by extending stage duration to 5 minute in 5-min protocol produced greater hemodynamic effects than those measured at 3 minutes of each stage, there were no significant difference in the results of 3-min and 5-min protocol of DSE. CONCLUSION: The increase of cardiac contractility most contributed to increase of cardiac output until 20microgram/kg/min dose and the increase of herat rate contributed dominantly thereafter, thus the hemodynamic variables showed different responses to increment of dobutamine dose. There were no significant difference in hemodynamic effects between the two protocols. So it is considered that 3-min protocol of DSE gives similar hemodynamic information as 5-min protocol and is more time-saving method.
Blood Pressure ; Cardiac Output ; Dobutamine* ; Echocardiography, Stress* ; Heart Rate ; Hemodynamics* ; Stroke Volume

BACKGROUND: In cases of pure mitral stenosis, it is known that the impairment of left ventricular(LV) ejection performance is frequently accompanied, but long term follow up studies on the LV ejection performance after successful percutaneous mitral valvuloplasty are rare on far. METHODS: An prospective investigation was performed on 32 casas of patients, 10 being male and 22 female, who have beem maintained after successful precutaneous mitral valvuloplasty of pure mitral stenosis. The LV ejection preformances have been measured with cardiomechanography and echocardiography before and following the procedure, and the follow-up periods were 24 months in average, in the range of 12 to 35 months. RESULTS: The stroke volume, cardiac output, cardiac index, ejection fraction, mean velocity of circumferential shortening and fractional shortening(FS), which are indices of LV ejection perfomance, all increased in follow-up than before procedure. In addition, LV end-diastolic dimension and LV end-diastolic dimension index, which are indicis of LV preload, increased, and the end-systolic LV wall stress which is an index of afterload, decreased. And the ratio measured FS to expected FS, which in an index of myocardial contractility, increased in follow-up. CONCLUSION: The successful percutaneous mitral valvuloplasty of pure mitral stenosis is found to improve LV ejection performance in long term by increasing preload, decreasing afterload, and increasing myocardial contractility of left venrticle.
Cardiac Output ; Echocardiography ; Female ; Follow-Up Studies ; Humans ; Male ; Mitral Valve Stenosis* ; Prospective Studies ; Stroke Volume