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Updated: Jul 29, 2026
Chronic Thromboembolic Pulmonary Hypertension and Assessment of Right Ventricular Function in the Piglet
Published on: November 4, 2015
Right ventricular injury in young swine: effects of catecholamines on right ventricular function and pulmonary
J J McGovern1, I M Cheifetz, D M Craig
1Division of Pediatric Cardiology, Duke Children's Hospital, Duke University Medical Center, Durham, North Carolina 27710, USA.
Insights
Epinephrine (EP) and other catecholamines improve right ventricular (RV) function after injury in piglets. EP uniquely reduced pulmonary vascular resistance and improved vascular efficiency, offering potential therapeutic benefits for pediatric cardiac surgery patients.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Physiology
- Anesthesiology
Background:
- Acute right ventricular (RV) injury is common in pediatric cardiac surgery patients.
- Limited data exists on optimal medical management, particularly regarding exogenous catecholamines.
- Lack of suitable animal models hinders laboratory investigation of RV injury and treatment.
Purpose of the Study:
- To evaluate the effects of dopamine, dobutamine, and epinephrine (EP) on RV function and pulmonary vasculature in a pediatric model of RV injury.
- To determine which catecholamine offers the most significant hemodynamic benefits in this setting.
Main Methods:
- Anesthetized piglets underwent cryoablation to induce RV injury.
- Epicardial transducers, micromanometers, and a pulmonary artery flow probe were used for hemodynamic monitoring.
- Dopamine, dobutamine, and EP were infused sequentially; RV contractility, diastolic function, and pulmonary vascular parameters were assessed.
Main Results:
- Cryoablation successfully induced reproducible RV injury, decreasing contractility and impairing diastolic function.
- All tested catecholamines improved RV systolic (preload recruitable stroke work) and diastolic function.
- Epinephrine (EP) significantly reduced pulmonary vascular resistance and improved transpulmonary vascular efficiency, outperforming dopamine and dobutamine.
Conclusions:
- Catecholamines can improve systolic and diastolic RV function following acute injury in a pediatric model.
- Epinephrine demonstrates superior effects on pulmonary hemodynamics, decreasing vascular impedance and enhancing efficiency.
- These findings suggest EP may be a valuable therapeutic option for managing RV dysfunction post-pediatric cardiac surgery.
Abstract:
Acute right ventricular (RV) injury is commonly encountered in infants and children after cardiac surgery. Empiric medical therapy for these patients results from a paucity of data on which to base medical management and the absence of animal models that allow rigorous laboratory testing. Specifically, exogenous catecholamines have unclear effects on the injured right ventricle and pulmonary vasculature in the young. Ten anesthetized piglets (9-12 kg) were instrumented with epicardial transducers, micromanometers, and a pulmonary artery flow probe. RV injury was induced with a cryoablation probe. Dopamine at 10 microg/kg/min, dobutamine at 10 microg/kg/min, and epinephrine (EP) at 0.1 microg/kg/min were infused in a random order. RV contractility was evaluated using preload recruitable stroke work. Diastolic function was described by the end-diastolic pressure-volume relation, peak negative derivative of the pressure waveform, and peak filling rate. In addition to routine hemodynamic measurements, Fourier transformation of the pressure and flow waveforms allowed calculation of input resistance, characteristic impedance, RV total hydraulic power, and transpulmonary vascular efficiency. Cryoablation led to a stable reproducible injury, decreased preload recruitable stroke work, and impaired diastolic function as measured by all three indices. Infusion of each catecholamine improved preload recruitable stroke work and peak negative derivative of the pressure waveform. Dobutamine and EP both decreased indices of pulmonary vascular impedance, whereas EP was the only inotrope that significantly improved transpulmonary vascular efficiency. Although all three inotropes improved systolic and diastolic RV function, only EP decreased input resistance, decreased pulmonary vascular resistance, and increased transpulmonary vascular efficiency.
