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James W. Jones
Thomas R. McLean
Lars G. Svensson
Arthur C. Beall
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Ann Thorac Surg 1992;54:44-49
© 1992 The Society of Thoracic Surgeons

Articles

Usefulness of right ventricular indices in early diagnosis of cardiac tamponade

James W. Jones, MD, PhD*, Najwa N. Izzat, PhD, Mohamed N. Rashad, MD, John I. Thornby, PhD, Thomas R. McLean, MD, Lars G. Svensson, MD, PhD, Arthur C. Beall, MD

The Cora and Webb Mading Department of Surgery, Baylor College of Medicine, and Veterans Affairs Medical Center, Houston, Texas USA

* Address reprint requests to Dr Jones, Surgical Service, 2002 Holcombe Blvd, Houston, TX 77030.

Early diagnosis of postoperative cardiac tamponade is impeded by its clinical similarity to left ventricular failure. Moreover, the hemodynamic changes necessary to diagnose cardiac tamponade are detected by conventional monitoring technique only after clinical compromise. Early signs of cardiac tamponade and left ventricular failure were studied with emphasis on right ventricular function in anesthetized dogs. One group (n = 20) had cardiac tamponade produced by incrementally increasing pericardial pressure (2 to 20 mm Hg), and another group (n = 20) had acute left ventricular failure produced by successive ligation of the anterior descending coronary artery at the lower, middle, and upper thirds. Besides standard hemodynamic measurements, right ventricular function was examined with a rapid-response thermodilution catheter. During cardiac tamponade, cardiac output, right ventricular ejection fraction, right ventricular stroke volume, and right ventricular end-diastolic volume were significantly decreased from baseline values after a pericardial pressure of 8 mm Hg or more (p < 0.05). Right atrial and pulmonary arterial pressures were not significantly elevated until 14 and 20 mm Hg of pericardial pressure, respectively. Although cardiac function in the left ventricular failure group was reduced after each ligation, right ventricular ejection fraction remained unchanged. This study suggests that right ventricular indices may facilitate earlier diagnosis of cardiac tamponade with greater accuracy.






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Copyright © 1992 by The Society of Thoracic Surgeons.