Regional myocardial blood flow during pericardial tamponade

The relative changes in myocardial blood flows within different parts of the heart were measured in anaesthetized thoracotomized dogs during and following effusive pericardial tamponade. Blood flows measured in a group of animals bled to the same arterial hypotensive levels served as experimental controls. The results demonstrate that regional myocardial blood flows to all areas were severely reduced during tamponade. Regional differences in the relative responses were evident; right and left atrial flows decreased more than left ventricular or septal flows which in turn decreased more than right ventricular endocardial flows decreased more than epicardial and the flow within the left side of the septal wall decreased more than the right. Although decreases in aortic pressure and ventricular volumes can account for some of these changes in flow seen in tamponade, alterations in extravascular compression appear to further reduce the myocardial perfusion and may be responsible for the differences in regional responses. In further experiments when the pericardial cavity was drained following 2 h of tamponade, a hyperemic response was seen throughout the heart indicating that the myocardial flow during tamponade may have been insufficient to meet the cardiac demands. In conclusion tamponade appears to result in a disproportionate decrease in myocardial blood flow to various parts of the heart which cannot be explained on the basis of a decrease in blood pressure or a reduction in ventricular volume.