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Cardiac Physiology Laboratory, Departments of 1 Cardiology and 2 Pediatrics, Leiden University Medical Center, Leiden, 2300 RC; 3 Department of Neonatology, Juliana Children's Hospital, 2566 MJ The Hague; and 4 Department of Neonatology, University Medical Center Utrecht, 3508AB Utretch, The Netherlands
Pulmonary hypertension results in an increased afterload for the right ventricle (RV). To determine the effects of this increased afterload on RV contractile performance, we examined RV performance before and during 4 h of partial balloon occlusion of the pulmonary artery and again after releasing the occlusion in nine newborn lambs. RV contractile performance was quantified by indexes derived from systolic RV pressure-volume relations obtained by a combined pressure-conductance catheter during inflow reduction. An almost twofold increase of end-systolic RV pressure (from 22 to 38 mmHg) was maintained during 4 h. Cardiac output (CO) (0.74 ± 0.08 l/min) and stroke volume (4.3 ± 0.4 ml) were maintained, whereas end-diastolic volume (7.9 ± 1.3 ml) did not change significantly during this period. RV systolic function improved substantially; the end-systolic pressure-volume relation shifted leftward indicated by a significantly decreased volume intercept (up to 70%), together with a slightly increased slope. In this newborn lamb model, maintenance of CO during increased RV afterload is not obtained by an increased end-diastolic volume (Frank-Starling mechanism). Instead, the RV maintains its output by improving contractile performance through homeometric autoregulation.
conductance catheter; end-systolic pressure-volume relation; homeometric autoregulation; pulmonary hypertension; right ventricular function.
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