Severe Valvular Disease

2017 ◽  
Author(s):  
Yafen Liang ◽  
Andrew Shaw
Keyword(s):  
Cardiac Output ◽  
Stroke Volume ◽  
Disease Severity ◽  
Perioperative Period ◽  
Valvular Disease ◽  
Organ Perfusion ◽  
Forward Flow ◽  
Pressure Dynamics ◽  
Valvular Diseases ◽  
Perioperative Assessment

The pathophysiology of valvular diseases follows the fundamental principles of fluid and pressure dynamics. Alteration in any of the major components that determine forward flow can translate into a change in stroke volume, which in turn results in a change in cardiac output. The goal of managing severe valvular disease in the perioperative period is to maintain the forward flow required for end organ perfusion and minimize regurgitation. Accordingly, this chapter discusses the major principles involved in the pathophysiology of valve disease, as well as the perioperative assessment of disease severity and appropriate management based upon the type of lesion being encountered.

IN SITU AND PILOT ORGAN PERFUSION TECHNIQUES FOR THE STUDY OF METABOLIC DYNAMICS

1972 ◽  
Vol 68 (2_Supplb) ◽  
pp. S9-S25 ◽  
Author(s):  
John Urquhart ◽  
Nancy Keller
Keyword(s):  
Cardiac Output ◽  
Large Fraction ◽  
Experimental Studies ◽  
Test Substance ◽  
Organ Perfusion ◽  
Systemic Blood ◽  
Experimental Control ◽  
Arterial Blood ◽  
Vascular Connections

ABSTRACT Two techniques for organ perfusion with blood are described which provide a basis for exploring metabolic or endocrine dynamics. The technique of in situ perfusion with autogenous arterial blood is suitable for glands or small organs which receive a small fraction of the animal's cardiac output; thus, test stimulatory or inhibitory substances can be added to the perfusing blood and undergo sufficient dilution in systemic blood after passage through the perfused organ so that recirculation does not compromise experimental control over test substance concentration in the perfusate. Experimental studies with the in situ perfused adrenal are described. The second technique, termed the pilot organ method, is suitable for organs which receive a large fraction of the cardiac output, such as the liver. Vascular connections are made between the circulation of an intact, anaesthetized large (> 30 kg) dog and the liver of a small (< 3 kg) dog. The small dog's liver (pilot liver) is excised and floated in a bath of canine ascites, and its venous effluent is continuously returned to the large dog. Test substances are infused into either the hepatic artery or portal vein of the pilot liver, but the small size of the pilot liver and its blood flow in relation to the large dog minimize recirculation effects. A number of functional parameters of the pilot liver are described.

scholarly journals Discriminating Reflux from Non-Reflux Diseases of Superficial Veins in Legs by Novel Non-Contrast MR with QFlow Technique

2021 ◽  
Vol 11 (4) ◽  
pp. 242
Author(s):  
Yuan-Hsi Tseng ◽  
Chien-Wei Chen ◽  
Min Yi Wong ◽  
Teng-Yao Yang ◽  
Bor-Shyh Lin ◽  
...  
Keyword(s):  
Stroke Volume ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Flow Volume ◽  
Mean Velocity ◽  
Forward Flow ◽  
Saphenous Veins ◽  
Venous Diseases ◽  
The Status ◽  
Stroke Distance

Objectives: To find an objective diagnostic tool for the superficial veins in legs. Methods: This study included 137 patients who underwent TRANCE-MRI from 2017 to 2020 (IRB: 202001570B0). Among them, 53 with unilateral leg venous diseases underwent a QFlow scan and were classified into the reflux and non-reflux groups according to the status of the great saphenous veins. Results: The QFlow, namely stroke volume (SV), forward flow volume (FFV), mean flux (MF), stroke distance (SD), and mean velocity (MV) measured in the external iliac, femoral, popliteal, and great saphenous vein (GSV). The SV, FFV, SD, MF, SD, and MV in the GSV (morbid/non-morbid limbs) demonstrated a favorable ability to discriminate reflux from non-reflux in the ROC curve. The SD in the GSV and GSV/PV ratio (p = 0.049 and 0.047/cutoff = 86 and 117.1) and the MV in the EIV/FV ratio, GSV, and GSV/PV ratio (p = 0.035, 0.034, and 0.025/cutoff = 100.9, 86.1, and 122.9) exhibited the ability to discriminate between reflux and non-reflux group. The SD, MV, and FFV have better ability to discriminate a reflux from non-reflux group than the SV and MF. Conclusions: QFlow may be used to verify the reflux of superficial veins in the legs. An increasing GSV/PV ratio is a hallmark of reflux of superficial veins in the legs.

scholarly journals Effects of Acute Bleeding Followed by Hydroxyethyl Starch 130/0.4 or a Crystalloid on Propofol Concentrations, Cerebral Oxygenation, and Electroencephalographic and Haemodynamic Variables in Pigs

2014 ◽  
Vol 2014 ◽  
pp. 1-12 ◽  
Author(s):  
Aura Silva ◽  
Ana Liza Ortiz ◽  
Carlos Venâncio ◽  
Almir P. Souza ◽  
Luísa Maria Ferreira ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Hydroxyethyl Starch ◽  
Cerebral Oxygenation ◽  
Plasma Concentrations ◽  
Volume Replacement ◽  
Cerebral Oximetry ◽  
Total Power ◽  
Organ Perfusion ◽  
Acute Bleeding ◽  
Young Pigs

Bleeding changes the haemodynamics, compromising organ perfusion. In this study, the effects of bleeding followed by replacement with hydroxyethyl starch 130/0.4 (HES) or lactated Ringer’s (LR) on cerebral oxygenation and electroencephalogram-derived parameters were investigated. Twelve young pigs under propofol-remifentanil anaesthesia were bled 30 mL/kg and, after a 20-minute waiting period, volume replacement was performed with HES (GHES;N=6) or LR (GRL;N=6). Bleeding caused a decrease of more than 50% in mean arterial pressure (P<0.01) and a decrease in cerebral oximetry (P=0.039), bispectral index, and electroencephalogram total power (P=0.04andP<0.01, resp.), while propofol plasma concentrations increased (P<0.01). Both solutions restored the haemodynamics and cerebral oxygenation similarly and were accompanied by an increase in electroencephalogram total power. No differences between groups were found. However, one hour after the end of the volume replacement, the cardiac output (P=0.03) and the cerebral oxygenation (P=0.008) decreased in the GLRand were significantly lower than in GHES(P=0.02). Volume replacement with HES 130/0.4 was capable of maintaining the cardiac output and cerebral oxygenation during a longer period than LR and caused a decrease in the propofol plasma concentrations.

MECHANISMS OF ADAPTATION OF THE LEFT VENTRICLE TO MUSCULAR EXERCISE

PEDIATRICS ◽  
1963 ◽  
Vol 32 (4) ◽  
pp. 660-670
Author(s):  
Jere H. Mitchell
Keyword(s):  
Cardiac Output ◽  
Left Ventricle ◽  
Stroke Volume ◽  
Pulse Rate ◽  
Individual Factors ◽  
Normal Male ◽  
Oxygen Intake ◽  
Mechanisms Of Adaptation ◽  
Male Subjects ◽  
Oxygen Difference

THE mechanisms of adaptation of the left ventricle to the demands of muscular exercise have intrigued cardiovascular physiologists for many years. Although highly complex, these adaptive mechanisms are more and more susceptible to analysis and quantification. In this presentation I will attempt to identify some of the individual factors which appear to be important in the response of the left ventricle to exercise, beginning with data obtained from experiments on conscious normal male subjects and proceeding to experiments performed on dog preparations in which individual factors were controlled and analyzed. The changes in oxygen intake, cardiac output, estimated arteriovenous oxygen difference, pulse rate and estimated mean stroke volume were determined in 15 normal male subjects during rest in the standing position and during treadmill exercise at the maximal oxygen intake level. Oxygen intake was obtained from the volume and composition of expired air, cardiac output by the dye dilution technique, and pulse rate from the electrocardiogram. Estimated arteriovenous oxygen difference was obtained by dividing the oxygen intake by the cardiac output (Fick principle) and estimated mean stroke volume by dividing the cardiac output by the heart rate. The data are shown in Figure 1. Oxygen intake increased from a mean value of 0.34 at rest to a maximal value of 3.22 L./min. The corresponding mean values for cardiac output were 5.4 and 23.4 L./min. and for arteriovenous oxygen difference were 6.5 and 14.3 ml./100 ml. Thus, as oxygen intake increased 9.5 times, the cardiac output increased 4.3 times and the arterio venous oxygen difference 2.2 times.

Cardiac Output Changes in Newborns With Hyperbilirubinemia Treated With Phototherapy

PEDIATRICS ◽  
1985 ◽  
Vol 76 (6) ◽  
pp. 918-921
Author(s):  
Frans J. Walther ◽  
Paul Y. K. Wu ◽  
Bijan Siassi
Keyword(s):  
Blood Flow ◽  
Cardiac Output ◽  
Stroke Volume ◽  
Skin Blood Flow ◽  
Peripheral Blood ◽  
Cardiovascular Effects ◽  
Tissue Perfusion ◽  
Peripheral Blood Flow ◽  
Limb Blood Flow ◽  
Term Infants

Phototherapy is known to increase peripheral blood flow in neonates, but information on the associated cardiovascular effects is not available. Using pulsed Doppler echocardiography we evaluated cardiac output and stroke volume in 12 preterm and 13 term neonates during and after phototherapy. We concomitantly measured arterial limb blood flow by strain gauge plethysmography and skin blood flow by photoplethysmography. Cardiac output decreased by 6% due to reduced stroke volume during phototherapy, whereas total limb blood flow and skin blood flow increased by 38% and 41%, respectively. Peripheral blood flow increments tended to be higher in the preterm than in the term infants. The reduced stroke volume during phototherapy may be an expression of reduced activity of the newborn during phototherapy. For healthy neonates the reduction in cardiac output is minimal, but for sick infants with reduced cardiac output, this reduction may further aggravate the decrease in tissue perfusion.

Long-term hemodynamic actions of atrial natriuretic factor (99-126) in conscious sheep

1988 ◽  
Vol 254 (4) ◽  
pp. H811-H815 ◽  
Author(s):  
D. G. Parkes ◽  
J. P. Coghlan ◽  
J. G. McDougall ◽  
B. A. Scoggins
Keyword(s):  
Blood Pressure ◽  
Cardiac Output ◽  
Stroke Volume ◽  
Blood Volume ◽  
Total Peripheral Resistance ◽  
Atrial Natriuretic Factor ◽  
Peripheral Resistance ◽  
Natriuretic Factor ◽  
Atrial Natriuretic

The hemodynamic and metabolic effects of long-term (5 day) infusion of human atrial natriuretic factor (ANF) were examined in conscious chronically instrumented sheep. Infusion of ANF at 20 micrograms/h, a rate below the threshold for an acute natriuretic effect, decreased blood pressure by 9 +/- 1 mmHg on day 5, associated with a fall in calculated total peripheral resistance. On day 1, ANF reduced cardiac output, stroke volume, and blood volume, effects that were associated with an increase in heart rate and calculated total peripheral resistance and a small decrease in blood pressure. On days 4 and 5 there was a small increase in urine volume and sodium excretion. On day 5 an increase in water intake and body weight was observed. No change was seen in plasma concentrations of renin, arginine vasopressin, glucose, adrenocorticotropic hormone, or protein. This study suggests that the short-term hypotensive effect of ANF results from a reduction in cardiac output associated with a fall in both stroke volume and effective blood volume. However, after 5 days of infusion, ANF lowers blood pressure via a reduction in total peripheral resistance.

Physiological factors associated with the lower maximal oxygen consumption of master runners

1989 ◽  
Vol 66 (2) ◽  
pp. 949-954 ◽  
Author(s):  
A. M. Rivera ◽  
A. E. Pels ◽  
S. P. Sady ◽  
M. A. Sady ◽  
E. M. Cullinane ◽  
...  
Keyword(s):  
Heart Rate ◽  
Cardiac Output ◽  
Stroke Volume ◽  
Maximal Oxygen Consumption ◽  
Maximal Heart Rate ◽  
Distance Runners ◽  
Physiological Factors ◽  
Factors Associated ◽  
Older Athletes ◽  
Maximal Cardiac Output

We examined the hemodynamic factors associated with the lower maximal O2 consumption (VO2max) in older formerly elite distance runners. Heart rate and VO2 were measured during submaximal and maximal treadmill exercise in 11 master [66 +/- 8 (SD) yr] and 11 young (32 +/- 5 yr) male runners. Cardiac output was determined using acetylene rebreathing at 30, 50, 70, and 85% VO2max. Maximal cardiac output was estimated using submaximal stroke volume and maximal heart rate. VO2max was 36% lower in master runners (45.0 +/- 6.9 vs. 70.4 +/- 8.0 ml.kg-1.min-1, P less than or equal to 0.05), because of both a lower maximal cardiac output (18.2 +/- 3.5 vs. 25.4 +/- 1.7 l.min-1) and arteriovenous O2 difference (16.6 +/- 1.6 vs. 18.7 +/- 1.4 ml O2.100 ml blood-1, P less than or equal to 0.05). Reduced maximal heart rate (154.4 +/- 17.4 vs. 185 +/- 5.8 beats.min-1) and stroke volume (117.1 +/- 16.1 vs. 137.2 +/- 8.7 ml.beat-1) contributed to the lower cardiac output in the older athletes (P less than or equal 0.05). These data indicate that VO2max is lower in master runners because of a diminished capacity to deliver and extract O2 during exercise.

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