• J. Cardiothorac. Vasc. Anesth. · Apr 2005

    Clinical Trial

    Analysis of diastolic function in patients undergoing aortic aneurysm repair and impact on hemodynamic response to aortic cross-clamping.

    • Rainer Meierhenrich, Albrecht Gauss, Thomas Anhaeupl, and Wolfram Schütz.
    • Department of Anesthesiology, University of Ulm, Ulm, Germany. rainer.meierhenrich@medizin.uni-ulm.de
    • J. Cardiothorac. Vasc. Anesth. 2005 Apr 1; 19 (2): 165-72.

    ObjectivesThe purpose of this study was to analyze left ventricular diastolic function in patients undergoing aortic aneurysm repair and to investigate the effects of laparotomy and aortic cross-clamping on diastolic function.DesignProspective clinical study.SettingUniversity hospital.ParticipantsForty-five consecutive patients undergoing open aortic aneurysm repair.InterventionsLeft ventricular diastolic function and hemodynamic variables were evaluated using transesophageal Doppler echocardiography and a pulmonary artery catheter at baseline, after laparotomy, and at 1 and 10 minutes after cross-clamping. Diastolic function was determined by Doppler derivatives of mitral inflow (E/A ratio, deceleration time of early inflow) and pulmonary venous flow (S/D ratio).Measurements And Main ResultsTwenty of 39 patients revealed signs of diastolic dysfunction at baseline. Of these 20 patients, 14 displayed delayed relaxation and 6 displayed a pseudonormal filling pattern. Patients with pseudonormal filling exhibited a lower stroke volume (p = 0.02) and cardiac index (p < 0.01) in comparison to patients with normal diastolic function. Laparotomy was associated with an improvement of diastolic function in 9 of 20 patients with preexisting diastolic dysfunction. Only 3 patients suffered impairment of diastolic function after cross-clamping. The hemodynamic response to cross-clamping did not differ between patients with normal and abnormal diastolic function.ConclusionsAbout 50% of patients undergoing aortic aneurysm repair exhibit signs of diastolic dysfunction. The majority of these patients showed delayed relaxation. Patients with pseudonormal filling displayed a significantly lower cardiac index. Laparotomy resulted in an improvement in diastolic function in about half of patients with preexisting diastolic dysfunction. The effects of cross-clamping on diastolic function are minimal.

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