Rewarming hypovolemia after aortocoronary bypass surgery

Coronary bypass performed with moderate systemic hypothermia (25 degrees C) and cold-potassium cardioplegia was associated with a fall and subsequent rise in core (pulmonary arterial) temperature. Serial hemodynamic measurements during rewarming and recovery revealed a decrease in cardiac index (CI) without a decrease in the left atrial pressure (LAP) of 17 patients recovering from uneventful coronary bypass surgery. Nuclear ventriculograms performed during rewarming demonstrated a decrease in left ventricular end-diastolic volume index (EDVI, calculated from the thermodilution stroke index divided by the nuclear ejection fraction) without a change in LAP. Volume loading during both mild hypothermia (35 +/- 5[SD]degrees C) and normothermia revealed that myocardial performance (the relation between CI and EDVI) was unchanged, but diastolic compliance (the relation between LAP and EDVI) decreased with rewarming. LAP was a poor indicator of left ventricular preload (EDVI) during rewarming, and volume loading was required to maintain preload and prevent hypoperfusion.