Cardiac Output and Intracardiac Pressures in Patients With Arteriovenous Fistulas 1

Epstein, Franklin H.; Shadle, O. W.; Ferguson, T. Bruce; McDowell, Marion E.

doi:10.1172/jci102770

Cited by 52 publications

(25 citation statements)

References 10 publications

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“…In man the cardiac output, heart rate, and right atrial pressure are elevated, arterial pulse pressure is increased (1)(2)(3)(4), and the blood volume is expanded (5). Similar effects have been observed in the dog with an experimentally induced fistula (6)(7)(8)(9)(10), and a reduction in peripheral blood flow (7) and renal blood flow (10) also has been observed.…”

Section: Introductionmentioning

confidence: 63%

Left ventricular function in experimental aorto-caval fistula with circulatory congestion and fluid retention

Taylor¹,

Covell²,

Ross³

1968

J. Clin. Invest.

108

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A B S T R A C T The mechanical properties of left ventricular contraction were described in terms of tension, velocity, length, and time in closed-chest, sedated dogs in which a large aorto-caval fistula had resulted in circulatory congestion, and the results were compared with those in normal dogs. Instantaneous contractile element velocity was calculated from left ventricular pressure and its first derivative during isovolumic left ventricular contractions produced by sudden balloon occlusion of the ascending aorta during diastole. A range of ventricular end-diastolic volumes was induced and heart rate was controlled at 150 beats/min. Wall tension (stress) was derived from ventricular pressure and volume, the latter being obtained from the pressure-volume relation of the passive ventricle. Extrapolated velocity at zero tension, Vmax, averaged 3.0 circ/sec in the normal dogs and 2.9 circ/sec in the seven dogs with an aortocaval fistula and fluid retention; in only one of these seven animals was Vmax below the lower limit of normal of 2.7 circ/sec. Isovolumic tension (PO) in dogs with aorto-caval fistulas tended to be slightly greater than normal at low ventricular filling pressures, and there was no difference in P. between the two groups of animals at high ventricular filling pressures. Time to peak pressure averaged 151 ± 6 (SE) msec (normal 139 ± 3). Left ventricular weight averaged 6.32 ±0.23 Dr. Taylor is a

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Section: Introductionmentioning

confidence: 63%

Left ventricular function in experimental aorto-caval fistula with circulatory congestion and fluid retention

Taylor¹,

Covell²,

Ross³

1968

J. Clin. Invest.

108

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“…When an arteriovenous shunt is occluded, the arterial tree is emptied more slowly and less -completely, and mean arterial pressure rises. Pressures in the great veins, the right atrium, and the pulmonary vessels tend to fall as these regions become less distended with blood (3,(18)(19)(20)(21). Cardiac output is decreased as the heart rate slows and stroke volume diminishes.…”

Section: Excretion Of Electrolytes and Watermentioning

confidence: 99%

“…When the fistula is opened, blood pours from arteries into veins. Despite an increase in cardiac output (3,4,19,(22)(23)(24), the arteries become less distended, and mean systemic arterial pressure falls, while the great veins become more swollen and pressures in the right atrium and pulmonary artery may increase (3,(18)(19)(20).…”

Section: Excretion Of Electrolytes and Watermentioning

confidence: 99%

The Effect of an Arteriovenous Fistula on Renal Hemodynamics and Electrolyte Excretion 1

Epstein¹,

Post²,

McDowell³

1953

J. Clin. Invest.

122

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“…Among possible reasons of small incidence rate and diverse severity in each patient, the size of a ductus can be a contributing factor. In arteriovenous fistula, patients with the largest arteriovenous communications tended to have the most marked changes in blood pressure when the fistula was occluded or released [8]. In the same manner, a larger ductus in PDA patients would have more change in blood pressure when occluded, giving more stimulus to the baroreceptor reflex.…”

Section: *Corresponding Authormentioning

confidence: 95%

“…When the arteriovenous fistula is compressed, the diastolic arterial pressure suddenly increases, with less increase of systolic arterial pressure [8,11]. Thus, the increased mean arterial pressure stimulates an arterial barore- , and 7 days after (C) the occlusion of PDA, showing a respiratory sinus arrhythmia (A) with normal heart rate at 114/min (50 mm/sec and 5 mm/mV), a profound respiratory bradycardia (B) at 66/min (50 mm/sec and 2.5 mm/mV), and the recovered heart rate (C) at 137/min (25 mm/sec and 5 mm/mV), respectively.…”

Section: *Corresponding Authormentioning

confidence: 99%

Prolonged reflex bradycardia after occlusion of patent ductus arteriosus with an Amplatz canine duct occluder in a dog

Ro¹,

Kang²,

Liu³

et al. 2017

Korean Journal of Veterinary Research

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A 9-month-old intact male Maltese dog (1.52 kg) was diagnosed with a patent ductus arteriosus (PDA). Transcatheter occlusion of the PDA was performed by using the Amplatz canine duct occluder (ACDO). After occlusion, reflex bradycardia occurred and lasted for at least 15 h with normal systolic arterial pressure and slightly increased diastolic arterial pressure. The bradycardia slowly resolved, and the heart rate was normal in re-examinations after 7 and 30 days. This is the first case of reflex bradycardia after ACDO implantation, in which the bradycardia continued for a long time, even after recovery from anesthesia.Keywords: Amplatz canine duct occluder, Branham-sign, patent ductus arteriosus, reflex bradycardia Patent ductus arteriosus (PDA), in which there is the persistence of ductus arteriosus after the early neonatal period, is one of the most commonly diagnosed congenital cardiovascular anomalies in dogs [4]. Among many approaches and devices currently used in occlusion of PDA, Amplatz canine duct occluder (ACDO) is considered superior in ease of use, complication rate, and completeness of occlusion [10,13].A sudden occlusion of PDA can induce a transient bradycardia in some patients, and this reflex bradycardia is explained by a phenomenon called "Branham sign", which is a decrease in heart rate (HR) and an increase in blood pressure after the sudden occlusion of arteriovenous fistula [2,7,12].Reflex bradycardia after PDA closure has been reported in surgical ligation, and in most of the cases, the postligation bradycardia was transient for a few minutes [3,14,15]. To the author's knowledge, this is the first case report of dog showing long duration of reflex bradycardia after occlusion of PDA with ACDO.A 9-month-old (body weight, 1.52 kg) intact male Maltese dog was referred due to an episode of syncope (loss of consciousness for a few seconds when excited) and abnormal heart sounds. During physical examination, a grade V/VI continuous heart murmur was auscultated at the left base of the heart, with the point of maximal intensity at the pulmonic valve area. Heart rate was 128 bpm and blood pressure was within normal range (systolic pressure 128 mmHg, diastolic pressure 83 mmHg, and mean arterial pressure 95 mmHg; Cardell 9402 Veterinary Monitor; Midmark, USA). Complete blood count and serum chemistry results were within normal range. Thoracic radiographs showed cardiomegaly (vertebral heart size = 11.8), increased pulmonary circulation, and left atrial and ventricular dilation were suspected. A left-to-right PDA was highly suspected on the basis of these findings. Transthoracic echocardiography (EPIQ 7 Cardiology Ultrasound Machine; Philips, USA) was performed for a definitive diagnosis. Dilation of the left atrium and ventricle (left-side volume overload) and a continuous turbulent flow in the main pulmonary artery were detected, and the PDA was visualized from both right parasternal view and left cranial parasternal view, with the minimum ductal diameter of 5 mm (Fig. 1). On continuous wav...

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Cardiac Output and Intracardiac Pressures in Patients With Arteriovenous Fistulas 1

Cited by 52 publications

References 10 publications

Left ventricular function in experimental aorto-caval fistula with circulatory congestion and fluid retention

Left ventricular function in experimental aorto-caval fistula with circulatory congestion and fluid retention

The Effect of an Arteriovenous Fistula on Renal Hemodynamics and Electrolyte Excretion 1

Prolonged reflex bradycardia after occlusion of patent ductus arteriosus with an Amplatz canine duct occluder in a dog

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