Effect of atrial septal defects on hemodynamic alterations caused by acute partial obstruction of pulmonary artery.

Abstract

Systemic and pulmonary blood flows and pressures were determined in anesthetized closed-chest dogs with chronic atrial septal defects and in dogs with intact cardiac septa. In the former animals, graded obstruction of the main pulmonary artery associated with right ventricular systolic pressures of more than 80 mm. Hg was produced without evidence of failure of the right side of the heart. A considerable decrease in the magnitude of the left-to-right shunts and an increase in the size of the right-to-left shunts occurred; these changes were associated with only minor changes in filling pressure of the right ventricle, and systematic changes in systemic arterial pressure did not appear. Analysis of right atrial pressure pulses suggested the development of an increased force of contraction of the right atrium and no evidence of tricuspid regurgitation under these circumstances. In contrast, partial obstruction of the main pulmonary artery in the dogs with intact cardiac septa, so as to increase the right ventricular systolic pressure to more than 60 mm. ITg, was associated with pronounced increases in mean right atrial pressure and striking decreases in cardiac output and systemic arterial pressure. The pressure recordings from the right atrium and indicator-dilution curves demonstrated the development of significant tricuspid regurgitation. The deterioration of right ventricular function in dogs with intact cardiac septa appears to be related to overdistention of the right ventricle and possibly also to a disproportionate reduction in coronary blood flow to the myocardium caused by a decrease in systemic arterial pressure and the concomitant increase in resistance to coronary venous drainage from the right side of the heart due to the increased right atrial and right ventricular pressures. It is concluded that under the conditions of these studies, an atrial septal defect provides a considerable increase in resistance to the heinodynamic effects associated with right ventricular hypertension caused by acute partial obstruction of the main pulmonary artery. The possible duration of this beneficial effect beyond the 33 to 160 minutes of observation in these studies has not been explored.