[Hemodynamic impact of tension ascites and evacuatory paracentesis]

Cardiac function is studied with regular hemodynamic determinations and 2D-doppler echocardiography, in 22 patients with massive ascites. Patients were divided in two groups: 1. Hepatic cirrhosis (n = 12) and 2. Peritoneal carcinomatosis (n = 10). Patients with carcinomatosis showed lowered heart-beat volume, cardiac output, ventricular work and ejection fraction in comparison with cirrhotic patients. In cirrhotic patients the hemodynamic study was done before and after an evacuatory paracentesis, following which an improvement in cardiac function was shown, with significant increments in heart-beat volume, cardiac output, ventricular work, and ejection fraction. 42% of the cirrhotic patients showed an hyperdynamic circulatory status in the baseline study, but after paracentesis this hyperkinetic status was present in 100% of the patients. It is suggested that tension ascites influences negatively in cardiac function because it difficult the venous return. This depression in the ventricular function is more obvious in patients with carcinomas that in cirrhotic patients due to the fact that the former do not have a previous circulatory status.