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J Thorac Cardiovasc Surg 1997;114:560-567
© 1997 Mosby, Inc.

SURGERY FOR CONGENITAL HEART DISEASE

ACUTE ELEVATION OF CORONARY VENOUS PRESSURE DOES NOT AFFECT LEFT VENTRICULAR CONTRACTILITY IN THE NORMAL AND STRESSED SWINE HEART: IMPLICATIONS FOR THE FONTAN OPERATION

Received for publication Dec. 4, 1996 revisions requested Jan. 15, 1997; revisions received April 23, 1997 accepted for publication April 28, 1997. Address for reprints: Jan Baan, PhD, Cardiac Physiology Laboratory, Department of Cardiology, C5-P University Hospital Leiden, P.O. Box 9600, 2300 RC Leiden, The Netherlands.

Abstract

Objective: After the Fontan operation the right atrium and, thus, the coronary sinus are connected to the pulmonary arterial system, which causes the coronary venous pressure to increase. We investigated the acute effects of elevation of coronary venous pressure on baseline hemodynamics, coronary venous flow, and left ventricular contractility. Methods: In acutely instrumented pigs, during complete right heart bypass and during constant cardiac output, pressure in the right atrium, right ventricle, and coronary sinus was altered by a height-adjustable reservoir. At various levels of coronary venous pressure (up to 4 kPa or up to 30 mm Hg), flow from the reservoir was measured and left ventricular hemodynamics and contractility were measured from catheter-derived left ventricular pressure and (conductance) volume data. Contractility of the left ventricle was assessed by the end-systolic pressure-volume relationship derived during an unloading intervention by adjusting the bypass pump speed. Results: Left ventricular end-diastolic pressure increased slightly (about 5%) with each kilopascal increase in coronary venous pressure, most likely related to diastolic ventricular interaction. No other changes in hemodynamic parameters occurred. Neither coronary venous flow nor left ventricular contractility was influenced by changes in coronary venous pressure. Imposing myocardial stress with dobutamine, 10 µg/kg per minute, did not change these findings. Conclusion: Increasing coronary venous pressure to 4 kPa in the intact circulation with intact autoregulation does not affect coronary flow or left ventricular contractility. We found no experimental evidence for the usefulness of diversion of the coronary sinus to the left atrium during Fontan-type operations.

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