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.

No abstract available.
Cardiac Output* ; Ultrasonography*

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*

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*

In 2D surgical paients wihose general anesthsia was maintained with one to one ratio of oxygen and nirtous oxide and 1 vo19 of halothane, 1 mg/kg of lidocaine was administered to the 10 patients in each group intravenously to evaluate the effects of lidocaine on cardiovascular changes. In these clinical study, heart rate (HR), mean arterial pressure (MAP), stroke volume (SV) and cardiac output (CO) were measured iri one minute interval after intravenous administration of lidocaine and these values were compared with the control. The following results were obtained: 1) There are no significant changes of the heart rate. 2) The mean arerial pressure was significantly decreased one minute after that, there was no significant change. 3) There were no signifieant changes in the stroke volume. 4) The cardiac outit was significantly decreased in all patients after the administration of lidocaine and there were also the significant decrease of the cardiac output three and four minutes in patients with 1.0 mg/kg of lidocaine and four and five minutes in patients with 1.5 mg/kg of lidocaine after the administration of lidocaine.
Administration, Intravenous ; Anesthesia* ; Arterial Pressure ; Cardiac Output ; Halothane* ; Heart Rate ; Humans ; Lidocaine* ; Oxygen ; 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

Effects of thoracentesis on thoracic impedance and cardiac performance were studied in patients with uncomplicated unilateral tuberculous pleural effusion. The speed of the removal of the pleural effusion in thoracentesis was essentially similar to that of a generally used for therapeutic purpose in daily practice. Thoracic impedance was measured in 23 cases before, 4 and 10 minutes after thoracentesis to the amount of pleural effusion aspirated was observed. In 11 cases out of 23, the changes in cardiac performance as assessed by stroke volume, cardiac output, heart rate, heather index and ratio of pre-ejection period to left ventricular ejection time(PEP/LVET) were observed 4 minutes after 150 ml to 1,000 ml of thoracentesis. In these cases, stroke volume, cardiac output, and Heather index were determined from impedance cardiograms, and PEP/LVET from mechanocardiograms recorded simultaneously with the former. A significant increase in thoracic impedance was observed both 4 and 10 minutes after thoracentesis. There was a slight but a significant correlation between the changes in thoracic impedance and the amount of pleural fluid aspirated only 4 minutes after thoracentesis. Thoracentesis showed no consistent influence on cardiac performance as reflected to stroke volume, cardiac output, heart rate, heart index and PEP/LVET. These facts suggest that measurement of thoracic impedance may be a useful method reflecting alterations in pleural fluid volumes, particularly when it occurs in a relatively short period of time, and the effects of thoracentesis of less than one liter on the cardiac functions as determined by the above-mentioned parameters were variable.
Cardiac Output ; Electric Impedance* ; Heart ; Heart Rate ; Humans ; Pleural Effusion ; Stroke Volume

The systolic time intervals and hemodynamics were measured in 10 cases of acute anemia and 28 cases of chronic anemia. The measurment was done by non invasive technique, i.e., simultaneous recording of ECG, PCG and carotid and femoral pulse tracing with paper speed 100mm/sec. Compared with healthy persons chronic anemia showed significant reduction of the systolic time intervals except QS1, but the systolic time intervals were unaltered when they were corrected by pulse rate, diastolic pressure and stroke volume. Acute anemia showed decreased of the systolic time intervals except QS1 also the decrease of isovolumic contraction time(ICT) and QS2 when corrected as above. The preejection period(PEP)/left ventricular ejection time(LVET) ratio were not altered. ICT, PEP and PEP/LVET ratio decreased in proportion to the levels of hemoglobin. The heart rate, stroke volume and cardiac output showed significant increase in chronic anemia but mild incease in acute one. The decrease of diastolic pressures and peripheral resistances were more pronounced in chronic anemia than in acute one.
Anemia* ; Blood Pressure ; Cardiac Output ; Electrocardiography ; Heart Rate ; Hemodynamics* ; Humans ; Stroke Volume ; Systole*

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

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