The hemodynamic response to dopamine and nitroprusside following right atrium-pulmonary artery bypass (Fontan procedure)

Donald Williams, P. D. Kiernan, H. V. Schaff, H. M. Marsh, G. K. Danielson

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Cardiac output is critically dependent upon pulmonary vascular resistance after right atrium-pulmonary artery bypass (Fontan procedure), since there is no pulmonary vantricle in the circulation. Inotropic agents, including dopamine, may increase pulmonary vascular resistance and, therefore, might have an adverse effect on cardiac output. The present study determined the hemodynamic responses to dopamine and nitroprusside of 9 patients following right atrium-pulmonary artery bypass. Particular attention was given to effects on cardiac output (CI), pulmonary vascular resistance, and right atrial pressure (RAP). Baseline hemodynamic data were measured without drugs, with dopamine at 7.5 μg/kg/min, with sodium nitropruside up to 5.0 μg/kg/min, and with a combination of dopamine, 7.5 μg/kg/min, and sodium nitroprusside, 1.0 μg/kg/min. Right and left atrial pressures (LAP), mean arterial blood pressure (BP), heart rate (HR), and CI were measured. Stroke volume index and pulmonary arteriolar resistance index were calculated. The increase in CI from baseline (1.98 ± 0.86 liters per minute) was significant for infusions of dopamine (2.75 ± 1.05, p < 0.001), sodium nitroprusside (2.57 ± 0.78, p < 0.001), and both drugs (2.74 ± 0.84, p < 0.001). The increased CI was achieved primarily by a significant increase in HR with dopamine and by an increase in stroke volume index with sodium nitroprusside. With a similar increment in CI, the RAP was significantly decreased from baseline (21 ± 4 torr) with sodium nitroprusside (15 ± 3, p < 0.001) but was unchanged with dopamine. Pulmonary arteriolar resistance index decreased significantly from baseline (375 ± 230 dynes sec cm-5/m2) with sodium nitroprusside (169 ± 132, p < 0.001), and, interestingly, with dopamine as well (273 ± 165, p < 0.05). Both dopamine and sodium nitroprusside in these dosages have favorable effects on CI and pulmonary arteriolar resistance index in patients after right atrium-pulmonary artery bypass. Whenever feasible, sodium nitroprusside is preferred for increasing CI after such a bypass procedure, since lower RAP decreases the severity of fluid retention, ascites, and chest tube drainage.

Original languageEnglish
Pages (from-to)51-57
Number of pages7
JournalAnnals of Thoracic Surgery
Volume34
Issue number1
DOIs
StatePublished - Sep 10 1982
Externally publishedYes

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Fontan Procedure
Nitroprusside
Heart Atria
Cardiac Output
Pulmonary Artery
Dopamine
Hemodynamics
Atrial Pressure
Vascular Resistance
Lung
Dopamine Agents
Patient Rights
Stroke Volume
Arterial Pressure
Heart Rate
Chest Tubes
Ascites
Drainage
Sodium

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

The hemodynamic response to dopamine and nitroprusside following right atrium-pulmonary artery bypass (Fontan procedure). / Williams, Donald; Kiernan, P. D.; Schaff, H. V.; Marsh, H. M.; Danielson, G. K.

In: Annals of Thoracic Surgery, Vol. 34, No. 1, 10.09.1982, p. 51-57.

Research output: Contribution to journalArticle

Williams, Donald ; Kiernan, P. D. ; Schaff, H. V. ; Marsh, H. M. ; Danielson, G. K. / The hemodynamic response to dopamine and nitroprusside following right atrium-pulmonary artery bypass (Fontan procedure). In: Annals of Thoracic Surgery. 1982 ; Vol. 34, No. 1. pp. 51-57.
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