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THE JOURNAL OF CARDIOVASCULAR SURGERY

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The Journal of Cardiovascular Surgery 1998 June;39(3):363-6

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

Right and left ventricular interaction in ventricular fibrillation with mechanical maintenance of the circulation

Charitos Ch. E., Nanas J. N., Nanas S. N., Chatzigeorgiou I., Alevizakos N., Cosmas K., Moulopoulos S. D.

From the Department of Clinical Therapeutics University of Athens, Medical School, Athens, Greece


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Objec­tive. To inves­ti­gate the pos­sible mech­a­nisms of ­right and ­left ven­tric­ular inter­ac­tion ­during ven­tric­ular fib­ril­la­tion (VF) ­with mechan­ical main­te­nance of the cir­cu­la­tion.
Experi­mental ­design. In ­this experi­mental ­study, two ­para-­aortic coun­ter­pul­sa­tion ­devices (­PACDs) ­were ­implanted in 14 mon­grel ­dogs.
Set­ting. The ­PACD is a ­spheroid, valve­less, ­with one ­opening, 100 ml ­stroke ­volume ­assisting ­device. ­After mid­ster­notomy and per­i­car­di­otomy, two ­PACDs ­were ­implanted on the ­ascending ­aorta and the pul­mo­nary ­artery, respec­tively. Cath­e­ters ­were ­placed ­into the ­aortic ­arch, and the ­left and ­right ven­tri­cles. An elec­tro­mag­netic ­probe was ­placed on the ­descending ­aorta.
Inter­ven­tions. ­After the com­ple­tion of the experi­mental prep­ar­a­tion, VF was ­induced and the two ­devices ­were syn­chron­ized and ­pumped simul­ta­ne­ously for 10 min­utes (A). Sub­se­quently, the ­left ­sided ­PACD ­pumped ­alone for the ­same ­period of ­time (B). ­This ­sequence was ­repeated 1-10 ­times in ­each experi­ment.
Meas­ures. The ­aortic pres­sures, the ­left and ­right ven­tric­ular pres­sures and the car­diac ­index ­were ­obtained at the end of ­each inter­ven­tion.
­Results. The simul­ta­neous ­pumping of the two ­devices (A) com­pared ­with the ­pumping of ­that ­implanted on the ­ascending ­aorta (B) ­resulted in: ­higher ­peak ­aortic pres­sure 119.1±32.1 ­mmHg (A) vs 105.7±36.4 ­mmHg (B), p<0.001, ­mean ­aortic pres­sure 42.1±13.2 ­mmHg vs 27.8±10.5 ­mmHg, p<0.001, ­mean ­left ven­tric­ular pres­sure 18.4+4.0 ­mmHg vs 11.7±3.6 ­mmHg, p<0.001, and car­diac ­index 105.7±40.1 ml/kg/min vs 82.0±39.9 ml/kg/mm, p<0.001, and ­lower ­right ven­tric­ular pres­sure 10.1±3.2 ­mmHg vs 13.3±2.6 ­mmHg, p<0.001.
Con­clu­sions. Main­te­nance of the cir­cu­la­tion ­during VF ­with the ­PACD ­implanted on the ­ascending ­aorta ­results in equal­iza­tion of the ­right and ­left ven­tric­ular pres­sures. In con­trast, ­when ­both ­devices are ­pumping simul­ta­ne­ously, the ­left ven­tric­ular pres­sure is sig­nif­i­cantly ­higher ­than the ­right one and the assis­tance is ­more effec­tive.

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