OBJECTIVES: To evaluate the influence of revascularization of a stenosis of the right coronary artery on right ventricular function. DESIGN: Prospective study. SETTING: Single institutional study in a university hospital. PARTICIPANTS: 20 patients with different degrees of stenosis of the right coronary artery undergoing elective coronary artery bypass grafting. INTERVENTIONS: In 10 patients, bypass surgery included revascularization of a significant stenosis of the right coronary artery (group 1). In 10 other patients, the pathology of the right coronary artery was judged to be not significant, without indication for revascularization (group 2). MEASUREMENTS AND MAIN RESULTS: Using the fast-response thermodilution pulmonary artery catheter, right ventricular function was estimated perioperatively. After termination of extracorporeal circulation, there was an increase in right ventricular volumes in group 2 (p < 0.05) and an initial decrease in group 1 (p < 0.05), with higher volumes in group 2 compared with group 1 (p < 0.05). The ejection fraction increased in group 1 (p < 0.05) and decreased in group 2 after operation (p < 0.05), with higher values in group 1 compared with group 2 (p < 0.05). In addition to these findings, the pressure-volume relationship showed a leftward and upward shift in group 1 and a rightward shift in group 2 postoperatively. CONCLUSIONS: These results indicate that right ventricular depression can occur after bypass grafting in patients with a moderate stenosis of the right coronary artery that is not revascularized. Revascularization of more severe stenosis of the right coronary artery appears to preserve postoperative right ventricular function.
OBJECTIVES: To evaluate the influence of revascularization of a stenosis of the right coronary artery on right ventricular function. DESIGN: Prospective study. SETTING: Single institutional study in a university hospital. PARTICIPANTS: 20 patients with different degrees of stenosis of the right coronary artery undergoing elective coronary artery bypass grafting. INTERVENTIONS: In 10 patients, bypass surgery included revascularization of a significant stenosis of the right coronary artery (group 1). In 10 other patients, the pathology of the right coronary artery was judged to be not significant, without indication for revascularization (group 2). MEASUREMENTS AND MAIN RESULTS: Using the fast-response thermodilution pulmonary artery catheter, right ventricular function was estimated perioperatively. After termination of extracorporeal circulation, there was an increase in right ventricular volumes in group 2 (p < 0.05) and an initial decrease in group 1 (p < 0.05), with higher volumes in group 2 compared with group 1 (p < 0.05). The ejection fraction increased in group 1 (p < 0.05) and decreased in group 2 after operation (p < 0.05), with higher values in group 1 compared with group 2 (p < 0.05). In addition to these findings, the pressure-volume relationship showed a leftward and upward shift in group 1 and a rightward shift in group 2 postoperatively. CONCLUSIONS: These results indicate that right ventricular depression can occur after bypass grafting in patients with a moderate stenosis of the right coronary artery that is not revascularized. Revascularization of more severe stenosis of the right coronary artery appears to preserve postoperative right ventricular function.
Authors: Beth Unsworth; Roberto P Casula; Andreas A Kyriacou; Hemang Yadav; Andrew Chukwuemeka; Ashok Cherian; Rex de Lisle Stanbridge; Thanos Athanasiou; Jamil Mayet; Darrel P Francis Journal: Am Heart J Date: 2010-02 Impact factor: 4.749