Cardiac function in patients with treated hypertension during aortic aneurysm repair

To investigate the impact of arterial hypertension on cardiac function during aortic cross-clamping and declamping.

Prospective study.

University hospital.

Twenty treated hypertensive males with slight left ventricular hypertrophy and 10 normotensive controls undergoing elective repair of an abdominal aortic aneurysm.

Using transesophageal echocardiography, the mitral inflow profile was evaluated during aortic cross-clamping and declamping.

During the clamping period, the ratio of peak atrial to peak early filling velocity (PA/PE) was significantly higher in the hypertensive patients. One minute after aortic cross-clamping, mean arterial pressure (MAP) and pulmonary artery occlusion pressure significantly increased in the hypertensive patients, whereas they did not change in the normotensive group. Cardiac index and heart rate significantly decreased after cross-clamping, and increased after clamp release in both groups. PA/PE significantly dropped in both groups after aortic declamping, and returned to baseline values thereafter. MAP also decreased significantly in both groups after clamp release, but the fall of MAP tended to be more pronounced in the hypertensive patients.

In the treated hypertensive patients, more pronounced hemodynamic and echocardiographic responses to aortic cross-clamping probably mirror the altered diastolic left ventricular function in these patients. With respect to intraoperative management, however, the treated hypertensive patients did not react grossly differently from the normotensive controls.