Chao-Xiang Jia

Validation Study of a New Transit Time Ultrasonic Flow Probe for Continuous Great Vessel Measurements

Continuous measurement of cardiac output is important during experimental and clinical cardiac surgery as an indicator of ventricular function. Previous flow probes underestimated flow secondary to position and flow (S-series probes; Transonic Systems, Inc., Ithaca, NY), required frequent calibrations (electromagnetic), and were cumbersome to use. The new A-series probe (ASP) by Transonic Systems, Inc., uses a new X method of ultrasonic illumination insensitive to perturbations in flow. The ASPs were found to be accurate during in vitro studies, but have not been validated in vivo. Six anesthetized pigs were instrumented for right atrium to left atrium bypass, and ASPs were placed on the ascending aorta and pulmonary artery. Baseline measurements included aortic (Ao) and pulmonic flow (P), and thermodilution (Td) cardiac output. Animals then were placed on right heart bypass, and flow was randomly varied from 1 to 6 L/min, and Ao flow was recorded. In addition, ASPs were rotated and their direction reversed. After data collection, the occlusive roller pump (RP) was calibrated using a timed collection method. Calibrated RP flows were plotted versus ASP flows, and regression was applied. There was no difference between mean Ao, P, and Td cardiac outputs at baseline. In addition, changes in position and direction of the probe did not affect measurement of flow. The ASPs showed a highly linear correlation with RP ([r = 0.98, p < 0.01] ASP[L/min] = 0.98 RP-0.032). During laminar flow states, ASPs are accurate and insensitive to position on the great vessels.

Iatrogenic Myocardial Edema: Increased Diastolic Compliance and Time Course of Resolution in Vivo

BACKGROUND Perfusion-induced edema reduces diastolic compliance in isolated hearts, but this effect and the time for edema to resolve after blood reperfusion have not been defined in large animals. METHODS Edema was induced by coronary perfusion with Plegisol (750 mL, 289 mOsm/L) during a 1-minute aortic occlusion in 6 pigs. This was followed by whole blood reperfusion, inotropic support, and circulatory assistance until sinus rhythm and contractile function were restored. A control group (n = 6) was treated similarly, with 1 minute of electrically induced ventricular fibrillation and no coronary perfusion. Recorded data included electrocardiogram, left ventricular pressure and conductance, aortic flow, and two-dimensional echocardiography. Preload reduction by vena caval occlusion was used to define systolic and diastolic properties. Data were recorded at baseline and at 15-minute intervals for 90 minutes after reperfusion. RESULTS In the edema group, average left ventricular mass (132 +/- 7 [standard error of the mean] versus 106 +/- 4 g) and ventricular stiffness constant (0.15 +/- 0.02 versus 0.05 +/- 0.01) increased after Plegisol versus baseline (p < 0.05), returning to normal after 45 minutes of reperfusion. In controls, mass (118 +/- 6 versus 116 +/- 4 g) and ventricular stiffness (0.06 +/- 0.01 versus 0.05 +/- 0.01) did not change significantly. There was no significant change in systolic function. Myocardial water content at the end of the study was not different for the two groups. CONCLUSIONS Crystalloid-induced edema and diastolic stiffness resolve after 45 minutes in pigs. This suggests that edema caused solely by cardioplegia during cardiac operations should not cause significant perioperative ventricular dysfunction.

Diastolic function in the heterotopic rat heart transplant model. Effects of edema, ischemia, and rejection.

Decreased systolic ventricular function and compliance and increased left ventricular edema and mass have been demonstrated in cardiac allograft rejection. Whether decreased left ventricular compliance in rejection is caused by myocardial edema has not been examined, and compliance in the Ono-Lindsey model has not been reported. Heterotopic rat abdominal cardiac transplantation was performed in ACI isografts (n = 24) and in ACI to Lewis allografts (n = 24). Subgroups were studied on posttransplantation days 0, 1, 3, and 5 (each n = 6). Both transplanted hearts and native hearts were arrested with potassium for the assessment of myocardial water content, heart weight, and the left ventricular pressure-volume relation. In transplanted hearts, myocardial water content did not change in isografts but increased on posttransplantation day 5 in allografts (81.1% on posttransplantation day 5 versus 76.1% on day 0, 77.2% on day 1, and 77.5% on day 3, p < 0.05). Wet and dry heart weight also increased on posttransplantation day 5 in allografts (p < 0.05). The left ventricular pressure-volume relation in transplanted hearts shifted to the left when compared with that in native hearts in all subgroups; these volume differences were statistically significant (p < 0.01) for all pressures above 7.5 mm Hg. This pattern was similar in isografts and allografts on posttransplantation days 0, 1, and 3, and no significant differences between isografts and allografts were demonstrated. On posttransplantation day 5, however, the pressure after a 0.05 ml injection in allografts was greater in transplanted hearts than in native hearts (24 +/- 3 versus 3 +/- 1 mm Hg, p < 0.01). The pressure difference between transplanted and native hearts was also significantly greater in allografts than in isografts (22 +/- 2 versus 6 +/- 1 mm Hg, p < 0.01), indicating an increase in stiffness of allografts. Thus edema and impaired diastolic properties occur concurrently with allograft rejection. Left ventricular volume is abnormal from posttransplantation days 0 to 5 in transplanted hearts but not native hearts in the Ono-Lindsey model with current methods, apparently because of ischemic injury during transplantation.

Myocardial edema: Comparison of effects on filling volume and stiffness of the left ventricle in rats and pigs

BACKGROUND This study compared the adverse effects of crystalloid-induced myocardial edema on left ventricular (LV) compliance in small and large hearts. METHODS Plegisol (289 mOsm/L) was perfused into the coronary arteries of pigs (n = 8) and 1:1 dilute Plegisol (145 mOsm/L) into the coronary arteries of rats (n = 6). Pressure-volume relations, heart weight, and water content were then determined. The pressure-volume relations were compared using an LV volume at a pressure of 10 mm Hg. RESULTS Edema in rats was associated with significant (p < 0.05) increases in heart weight (1.1 +/- 0.0 g versus 1.4 +/- 0.1 g [average +/- standard error of the mean]) and water content (76.8% +/- 0.4% versus 81.3% +/- 0.8%), but an increase in LV stiffness (7.91 +/- 0.52 versus 9.27 +/- 1.42) and a decrease in the LV volume at 10 mm Hg (0.25 +/- 0.02 mL versus 0.14 +/- 0.05 mL) were not statistically significant. Edema in pigs was associated with statistically significant (p < 0.05) increases in LV stiffness beta (0.050 +/- 0.004 versus 0.072 +/- 0.008), heart weight (207 +/- 8 g versus 274 +/- 9 g), and water content (79.8% +/- 0.6% versus 85.3% +/- 0.6%) and a significant decrease in the LV volume at 10 mm Hg (88.4 +/- 5.8 mL versus 60.4 +/- 6.8 mL). CONCLUSIONS Myocardial edema is associated with an increase in water content and LV stiffness and a decrease in the LV volume at 10 mm Hg in both species. In rats, however, the water content is smaller in the control state and a more hypotonic perfusate is needed to induce a given degree of edema.

Electrical isolation of the heart. Stabilizing parallel conductance for left ventricular volume measurement.

Modern indices of left ventricular function require accurate measurement of left ventricular volume (LVV). Although conductance catheter (COND) measurements of LVV have been found to be reproducible under steady state conditions in closed chest animals, after median sternotomy, measurements of LVV are subject to exaggerated variation in parallel conductance (αPVc) outside of the left ventricle. Current calibration methods for measuring αPVc include hypertonic saline injection and quantitative two dimensional echocardiography. Unfortunately, these methods are hampered by imprecision, since frequent changes in αPVc in the open chest make recalibration impractical. Accordingly, a latex wrap technique was developed to insulate the left ventricle from extracardiac sources of αPVc in the open chest. Anesthetized pigs (n = 5) underwent a median sternotomy with insertion of a 6 French COND-micromano-meter combination catheter into the left ventricle. Three conditions were tested: 1) unaltered; 2) metallic retractor outside of the pericardium (metal); and 3) latex wrap between the metal and pericardium. Pressure/COND loops showed that the insulator improved the shape of the loops and decreased αPVc, as measured by an echo-area/COND relationship, whereas metal increased αPVc and produced artifacts in the loops. In conclusion, electrical isolation eliminates distortion of pressure/COND loops related to extracardiac sources of αPVc, therefore allowing for accurate COND measurements in the open chest. ASAIO Journal 1997; 43:M509-M514.

Conductance–Echocardiography Correlation During Changes In Left Ventricular Volume

Conductance (COND) measurements of left ventricular volume, satisfactory under steady state conditions, may be altered by extraneous factors during complex experiments or cardiac surgery. A reference technique is needed to detect changes in the COND-left ventricular volume relationship. This technique should indicate when recalibration of COND is needed. Accordingly, we assessed the relationship between left ventricular COND and the area of left ventricular short-axis cross section (SACS) by two-dimensional echocardiography during vena caval occlusion. Thirteen anesthetized pigs underwent a median sternotomy and insertion of a COND catheter. Two-dimensional echocardiography and COND were displayed and recorded simultaneously on a digital video monitor. Data were analyzed at end-diastole during the filling phase after vena caval occlusion, because the quality of two-dimensional echocardiography was better during recovery. Results demonstrated a linear relationship between left ventricular COND and SACS at end-diastole, with a positive slope. Correlation coefficients ranged from 0.88 to 1.0 and averaged 0.96 +/- 0.01 (SE). The overall mean relationship was (SACS) = 0.40 (COND) - 17. It is concluded that SACS by two-dimensional echocardiography can be employed to confirm COND measurements of left ventricular end-diastolic volume during laboratory experiments or cardiac surgery. Stability of the SACS-COND relationship indicates that COND calibration is valid. Changes in the SACS-COND relationship would require recalibration of COND. Data markedly deviating from a linear SACS-COND relation reflect experimental error and should be discarded.

REVERSAL OF IATROGENIC MYOCARDIAL EDEMA AND RELATED ABNORMALITIES OF DIASTOLIC PROPERTIES IN THE PIG LEFT VENTRICLE

OBJECTIVE This study examines the resolution of iatrogenic edema and related changes in systolic and diastolic properties in the intact pig left ventricle. METHODS The coronary arteries were perfused for 50 to 60 seconds with diluted blood (hematocrit value 10% +/- 1%, edema group, n = 5) or whole blood (hematocrit value 28% +/- 1%, control group, n = 6) infused into the aortic root during aortic crossclamping in conditioned, anesthetized pigs. After whole blood reperfusion, preload reduction by vena caval occlusion was used to define systolic and diastolic properties at 15-minute intervals. Left ventricular pressure and conductance, aortic flow, and two-dimensional echocardiography were recorded. RESULTS Left ventricular mass (wall volume) in the edema group increased significantly compared with that in control pigs after crossclamp removal. Mass returned to preperfusion levels after 45 minutes. The ventricular stiffness constant (beta) increased significantly in the edema group versus the control group, returning to baseline by 30 minutes. The diastolic relaxation constant (tau) and base constant (alpha) did not differ between groups. There was no significant change in contractility. CONCLUSION Increases in left ventricular mass and diastolic stiffness induced by coronary perfusion with hemodiluted blood resolve after 45 minutes of whole blood perfusion in pigs. This study defines physiologic effects of edema in the normal heart while eliminating most common confounding experimental errors.

Systolic Arterial Pressure Recovery After Ventricular Fibrillation/Flutter in Humans

Although the elective induction of cardiac arrest for implantable defibrillator insertion under general anesthesia is widely used, the hemodynamics of recovery of arterial blood pressure after cardiac arrest is not well‐defined. Accordingly, the time course of recovery of systolic arterial pressure was studied in seven patients during the repetitive induction of ventricular fibrillation (n = 6) or ventricular flutter (n = 1). The mean number of episodes of cardiac arrest was 7 ± 2, and the mean drop in systolic pressure was 84 ± 16mmHg. The mean recovery time for systolic pressure was 10 ± 6 seconds, the average systolic pressure recovery rate was 13 ± 14 mmHg/sec, and the mean percent systolic pressure recovery was 94%± 9%. A negative logarithmic relation was found to exist between the rate of systolic arterial pressure recovery and the duration of ventricular fibrillation or flutter with a correlation coefficient of 0.68 to 0.97 (P < 0.05) in five of the seven patients. A linear relation between the time for systolic pressure recovery and duration of asystole was also defined. These results are consistent with the view that prolongation of ventricular fibrillation or flutter increases the duration of arterial pressure recovery through a negative effect on left ventricular contractility. Increased understanding of these relations may lead to increased safety of implantable defibrillator insertion.

Conductance artifacts in a novel in vitro model of ventriculothoracic electrical coupling.

The utility of open chest conductance (COND) ventriculography is limited by artifacts altering the relationship between COND and left ventricular (LV) volume. Pressure-COND loops often lean to the left during LV volume reduction by caval occlusion. Time varying alterations in the pericardial-LV contact area affect electrical coupling in the open chest during the cardiac cycle, producing COND artifacts. In this study, an open-mediastinum model was constructed. Components represented the LV, blood, pericardium, and thoracic contents. Varying ventriculothoracic coupling was simulated by changing the volume of pericardial saline (0, 30, 60 ml). Raw dual field COND was repeatedly (n = 20) compared with volumes of normal saline from 60 to 120 ml at 5 ml intervals. Groups were compared by linear regression and repeated measures ANOVA. Artifacts significantly (p < 0.01) altered parallel COND, indicated by the y-intercept, with the exception of 0 versus 30 ml. The slope constant also changed significantly, with the exception of 30 versus 60 ml. These results suggest that variable pericardial-LV contact can cause time varying artifacts in COND in the open chest. Therefore, posterior insulation may reduce artifacts in COND ventriculography and should be tested for this effect.

A Method for Detecting Changes in Left Ventricular Mass During Variations in Filling Volume

Two-dimensional echocardiography has been useful for measuring changes in left ventricular mass (LVM) at constant left ventricular end-diastolic volume (LVEDV). Two-dimensional echocardiographic measurement of LVM changes during variations in LVEDV requires definition of the LVM/LVEDV relation because two-dimensional echocardiographic measurements could be affected by asymmetrical redistribution of LVM. Echocardiography data were recorded during caval occlusions in pigs (n = 6). Results confirm that A(M) (left ventricular [LV] short-axis cross-sectional [SACS] wall thickness area), was inversely related to AL (LV SACS lumen area), the average relation being A(M) = -0.33 AL + 20 (r = 0.82 +/- 0.05 [SE]). In addition, we developed a model that computes normal relation between LV SACS wall thickness area (AMc) and LV SACS lumen area (ALc) over a physiologic range of LVEDVs based on a single end-diastolic two-dimensional echocardiographic SACS image. Each computed relation corresponds uniquely to an LVM (LVMc). Theoretically, a difference between AMc/ALc relation before an intervention and the computed relation after the intervention would indicate a change in LVM. To test the utility of this model, edema was induced in a second group of pigs (n = 6) by coronary hemodilution. Two conditions were tested: pre-edema and edema. Serial AMc/ALc and LVMc were computed. Pre-edema and edema AMc were compared at matched LV SACS end-diastolic areas (ALc = 15 cm2). Results showed a significant increase in LVMc (two-tailed p value < 0.05), as observed by two-dimensional echocardiography. We conclude that the A(M) and AL are inversely related. This relation is useful for detecting alterations in LVM during variations in LVEDV.