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Related Experiment Videos

Ventricular pump performance during hypocalcemia: clinical and experimental studies.

P M Stulz, D Scheidegger, L J Drop

    The Journal of Thoracic and Cardiovascular Surgery
    |August 1, 1979
    PubMed
    Summary

    Rapid blood transfusion with citrate lowers calcium, potentially impairing heart function. Heparinized blood, however, improves cardiac output and ventricular function without affecting calcium levels.

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    Area of Science:

    • Cardiology
    • Physiology
    • Transfusion Medicine

    Background:

    • Rapid blood transfusions are common in cardiac surgery.
    • Citrate, an anticoagulant, can chelate calcium, potentially affecting cardiac function.
    • Understanding the impact of different anticoagulants on ventricular function is crucial.

    Purpose of the Study:

    • To compare the effects of rapid autologous blood transfusion using citrated versus heparinized blood on ventricular function.
    • To investigate the role of ionized calcium levels in mediating these effects.

    Main Methods:

    • Six patients undergoing cardiopulmonary bypass received rapid infusions of either citrated or heparinized autologous blood.
    • Measurements included plasma ionized calcium concentration, pulmonary artery occlusion pressure, and left ventricular performance indices (stroke work index, stroke index, cardiac index).

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  • A canine model was used to further assess ventricular function under hypocalcemia and beta-blockade.

    • Main Results:

    • Citrated blood transfusion led to a significant decrease in plasma ionized calcium and an increase in pulmonary artery occlusion pressure, without altering left ventricular performance indices.
    • Heparinized blood transfusion did not affect plasma ionized calcium but increased pulmonary artery occlusion pressure and improved left ventricular stroke work index, stroke index, and cardiac index.
    • In dogs, severe hypocalcemia shifted ventricular function curves downward and to the right, indicating impaired function.
    • Combined hypocalcemia and beta-blockade resulted in severe left ventricular failure.

    Conclusions:

    • Rapid transfusion of citrated blood may transiently impair ventricular function due to hypocalcemia.
    • Heparinized blood transfusion appears to be better tolerated, potentially improving cardiac performance.
    • Hypocalcemia significantly depresses left ventricular function, an effect exacerbated by beta-blockade.