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*

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

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

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 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*

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