The proposed research plan is centered upon the quantification of left atrial-left ventricular interactions. The hypothesis to be tested is that current techniques of myocardial preservation do not afford adequate protection of the left atrium. With the broadening indications for cardiac surgery, patients with impaired ventricular function will require the preservation of atrial function for survival. Additionally, impaired ventricular function, both mechanical and electrophysiologic, can lead to abnormalities of mitral valve function that will also effect left atrial function. Arrhythmias, both ventricular and supraventricular are common following cardiac operations, and are due to the same deficits in preservation that leads to atrial dysfunction. As well, chronic valvular heart disease leads to chronic supraventricular arrhythmias despite valve replacement or repair. Left atrial isolation, a method to be used in the study of atrioventricular interaction, is also a potential electrophysiologically specific operation to minimize the deleterious effects of supraventricular arrhythmias on cardiac function in patients with mitral valve disease. Atrioventricular interactions will be studies in an animal model using echocardiography as a screening procedure. The model will incorporate features of cardioplegic arrest, coronary occlusion, programmed electrical stimulation and left atrial isolation to mimic changes in cardiac surgery and to isolate functional aspects of atrioventricular interaction. Detailed analysis of left atrial function will be accomplished using ultrasonic dimension transducers, high fidelity intracavitary pressure measurement and the electromagnetic measurement of transmitral blood flow. The above mentioned techniques will be used to perturb the model systems. Using computer analysis, the left atrium will be modeled as a hemispheroid and left atrial work quantified. Left atrial isolation will also be studied in its own right in a colony of animals subjected to this procedure followed by prolonged survival.
| Kabas, J S; Kisslo, J; Flick, C L et al. (1990) Intraoperative perfusion contrast echocardiography. Initial experience during coronary artery bypass grafting. J Thorac Cardiovasc Surg 99:536-42 |
| Smith, P K; Stanley 3rd, T E (1990) Intraoperative contrast echocardiography: a direct approach to measure regional myocardial perfusion. Anesthesiology 72:219-21 |
