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Related Experiment Videos

Protamine and left ventricular function: a transesophageal echocardiography study

M R Del Re1, J D Ayd, L W Schultheis

  • 1Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland.

Anesthesia and Analgesia
|December 1, 1993
PubMed
Summary

Protamine sulfate may negatively impact heart function in patients with reduced ejection fraction after cardiopulmonary bypass. This effect on ventricular function was observed in patients with impaired preoperative ejection fraction.

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Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Pharmacology

Background:

  • Protamine sulfate is used to neutralize heparin after cardiopulmonary bypass (CPB).
  • The potential effects of protamine sulfate on cardiac function are not fully understood, particularly in patients with pre-existing ventricular dysfunction.

Purpose of the Study:

  • To evaluate the effect of protamine sulfate administration on left ventricular function in patients undergoing heart surgery requiring CPB.
  • To determine if protamine sulfate has a differential impact on ventricular function based on preoperative ejection fraction.

Main Methods:

  • Twenty-three patients undergoing heart surgery with CPB were studied.
  • Left ventricular function was assessed using cardiac index (thermodilution pulmonary artery catheter) and fractional shortening (transesophageal echocardiography).

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  • Measurements were taken before, during, and after protamine sulfate infusion.

    • Main Results:

    • Patients with preoperative ejection fraction >= 50% showed no significant changes in cardiac index or fractional shortening.
    • Patients with preoperative ejection fraction < 50% experienced a significant decrease in fractional shortening during and after protamine administration (P < 0.01).
    • No significant hemodynamic changes were associated with the observed decrease in fractional shortening in the impaired function group.

    Conclusions:

    • Protamine sulfate may exert a negative inotropic effect.
    • This negative inotropic effect is primarily apparent in patients with impaired preoperative left ventricular function.
    • Further investigation into the cardiac effects of protamine sulfate in vulnerable patient populations is warranted.