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Effects of milrinone and epinephrine or dopamine on biventricular function and hemodynamics in right heart failure after pulmonary regurgitation

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  • Janus Adler Hyldebrandt
  • Peter Agger
  • Eleonora Sivén
  • Kristian Borup Wemmelund
  • Johan Heiberg
  • Christian Alcaraz Frederiksen
  • Hanne Berg Ravn
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Right ventricular failure (RVF) secondary to pulmonary regurgitation (PR) impairs right ventricular (RV) function and interrupts the interventricular relationship. There are few recommendations for the medical management of severe RVF after prolonged PR. PR was induced in 16 Danish landrace pigs by plication of the pulmonary valve leaflets. Twenty-three pigs served as controls. At reexamination the effect of milrinone, epinephrine, and dopamine was evaluated using biventricular conductance and pulmonary catheters. Seventy-nine days after PR was induced, RV end-diastolic volume index (EDVI) had increased by 33% (P = 0.006) and there was a severe decrease in the load-independent measurement of contractility (PRSW) (-58%; P = 0.003). Lower cardiac index (CI) (-28%; P < 0.0001), mean arterial pressure (-15%; P = 0.01) and mixed venous oxygen saturation (SvO2) (36%; P < 0.0001) were observed compared with the control group. The interventricular septum deviated toward the left ventricle (LV). Milrinone improved RV-PRSW and CI and maintained systemic pressure while reducing central venous pressure (CVP). Epinephrine and dopamine further improved biventricular PRSW and CI equally in a dose-dependent manner. Systemic and pulmonary pressures were higher in the dopamine-treated animals compared with epinephrine-treated animals. None of the treatments improved stroke volume index (SVI) despite increases in contractility. Strong correlation was detected between SVI and LV-EDVI, but not SVI and biventricular contractility. In RVF due to PR, milrinone significantly improved CI, SvO2, and CVP and increased contractility in the RV. Epinephrine and dopamine had equal inotropic effect, but a greater vasopressor effect was observed for dopamine. SV was unchanged due to inability of both treatments to increase LV-EDVI.

Original languageEnglish
JournalAmerican Journal of Physiology: Heart and Circulatory Physiology
Volume309
Issue number5
Pages (from-to)H860-6
ISSN0363-6135
DOIs
Publication statusPublished - Sep 2015
Externally publishedYes

    Research areas

  • Animals, Cardiotonic Agents, Dopamine, Epinephrine, Heart Failure, Hemodynamics, Milrinone, Pulmonary Valve Insufficiency, Swine, Ventricular Function, Journal Article, Research Support, Non-U.S. Gov't

ID: 50673928