Radionuclide assessment of cardiac function. Pre-operative evaluation of patients with abdominal aortic occlusive disease undergoing aortobifemoral bypass grafting.

Abstract

Pre-operative radionuclide angiography, a non-invasive technique for evaluating ventricular function, was performed on 34 consecutive patients undergoing aortobifemoral bypass grafting for abdominal aortic occlusive disease, to determine whether pre-existing coronary artery disease causes significant modification of cardiac function. Patients were divided into two groups according to medical history. Group I had 23 patients with no symptoms of coronary artery disease and Group II had 11 patients, six with previous myocardial infarction and five with angina pectoris. There was a significant difference in left ventricular ejection fraction and in cardiac output between these two groups. A flow-directed pulmonary artery catheter was inserted in eight patients in Group II who had an ejection fraction less than 50% and a nitroglycerin infusion was used in six cases to maintain pulmonary capillary wedge pressure below 20 mmHg. In the other patients, only central venous pressure was monitored. All patients had uneventful operative courses. It is concluded that left ventricular function is significantly altered in patients with symptoms of both abdominal aortic occlusive disease and coronary artery disease. By contrast, cardiac function is normal in patients free from symptoms of coronary artery disease, and central venous pressure monitoring seems sufficient in the management of these patients during aortobifemoral bypass grafting.