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Assessment of left ventricular performance during laparoscopy.

A Russo1, E Di Stasio, F Bevilacqua

  • 1Department of Anesthesiology and Intensive Care Medicine, and Institute of Biochemistry and Clinical Biochemistry, School of Medicine, Catholic University of the Sacred Heart, Rome, Italy. francescabevilacquamd@gmail.com.

European Review for Medical and Pharmacological Sciences
|September 16, 2014
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Summary

Pneumoperitoneum during laparoscopic surgery increases left ventricular wall stress and reduces fiber shortening velocity. These cardiac effects are temporary, with function returning to normal after surgery, indicating cardiac adaptation to pressure overload.

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Area of Science:

  • Cardiology
  • Anesthesiology
  • Surgical Innovation

Background:

  • Laparoscopic surgery utilizes carbon dioxide insufflation (pneumoperitoneum), increasing intra-abdominal pressure.
  • The effects of pneumoperitoneum on cardiac performance, particularly left ventricular function, are not fully understood.
  • Elevated intra-abdominal pressure may acutely affect left ventricular wall stress and workload.

Purpose of the Study:

  • To evaluate the impact of pneumoperitoneum on echocardiographic measures of left ventricular contractile function.
  • To investigate the hypothesis that 12 mmHg intra-abdominal pressure acutely affects left ventricular wall stress and work.
  • To assess cardiovascular changes during laparoscopic procedures.

Main Methods:

  • Twenty healthy women (ASA I) undergoing laparoscopic hysterectomy were studied.
  • Transthoracic echocardiography was performed at multiple time points: preoperatively, post-anesthesia induction, after pneumoperitoneum, after Trendelenburg positioning, and post-surgery.
  • Left ventricular end-systolic wall stress, stroke work, ejection time, and mean velocity of fiber shortening were measured.

Main Results:

  • Pneumoperitoneum significantly increased left ventricular end-systolic wall stress and left ventricular ejection time.
  • Mean velocity of fiber shortening decreased, indicating reduced myocardial contractility.
  • Trendelenburg positioning had no significant additional effects, and all measured parameters normalized by the end of surgery.

Conclusions:

  • Pneumoperitoneum adversely affects left ventricular performance during laparoscopy.
  • The observed cardiac changes represent a reversible adaptation to the increased pressure load.
  • The study suggests systolic contractile status adapts to pressure overload during laparoscopy.