Transesophageal two-dimensional echocardiographic evaluation of biventricular dimension and function during positive end-expiratory pressure ventilation after coronary artery bypass grafting |
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| Authors: | J J Koolen C A Visser E Wever H van Wezel N G Meyne A J Dunning |
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| Institution: | 1. Cardiology Department, University Hospital Brno, Brno, Czech Republic;2. Faculty of Medicine, Masaryk University, Brno, Czech Republic;3. Institute of Pathological Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic;4. Department of Biochemistry, Faculty of Medicine, Masaryk University, Brno, Czech Republic;5. Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic;6. Department of Anaesthesiology and Critical Care Medicine, Lariboisière University Hospital, AP-HP University Paris Diderot, Paris, France;7. Cardiac Diseases and Biomarkers, INSERM UMR 942, Lariboisière University Hospital Paris, France;8. Department of Biochemistry, University Hospital Brno, Brno, Czech Republic;9. Department of Laboratory Methods, Faculty of Medicine, Masaryk University, Brno, Czech Republic;1. Cardiovascular Research Center, Heart Institute, Hadassah-Hebrew University Medical Center, Jerusalem, Israel;2. Department of Cardiology, Sheba Medical Center, Tel Hashomer, Israel;3. Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel;4. Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel;5. Department of Cardiology, Meir Medical Center, Kfar Saba, Israel |
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| Abstract: | Transesophageal 2-dimensional echocardiography was performed in 21 patients soon after uncomplicated coronary artery bypass grafting to determine the mechanism of positive end-expiratory pressure (PEEP) ventilation-induced decreased cardiac output. End-diastolic and end-systolic short-axis area and percent area reduction of right and left ventricles were determined during 5-cm H2O stepwise increments of PEEP ventilation. Simultaneously, cardiac output and right- and left-sided hemodynamic values were determined. Cardiac output, mean arterial pressure and end-diastolic area of both ventricles gradually decreased, and right and left atrial and pulmonary arterial pressures (mainstem and capillary wedge) increased. Left ventricular end-systolic area did not change, whereas right ventricular area decreased. Percent area reduction of both ventricles decreased (p less than 0.01). Thus, decrease in cardiac output during PEEP ventilation is primarily caused by decrease of preload rather than compromised contractility. |
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