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Effect of Aortic Insufficiency on Arterial Blood Pressure, Coronary Blood Flow and Cardiac Oxygen Consumption

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Effect of Aortic Insufficiency on Arterial Blood Pressure, Coronary Blood Flow and Cardiac Oxygen Consumption EFFECT OF AORTIC INSUFFICIENCY ON ARTERIAL BLOOD PRESSURE, CORONARY BLOOD FLOW AND CARDIAC OXYGEN CONSUMPTION René Wégria, … , Robert Jreissaty, Jiro Nakano J Clin Invest. 1958;37(3):471-475. https://doi.org/10.1172/JCI103627. Research Article Find the latest version: https://jci.me/103627/pdf EFFECT OF AORTIC INSUFFICIENCY ON ARTERIAL BLOOD PRESSURE, CORONARY BLOOD FLOW AND CARDIAC OXYGEN CONSUMPTION' By RENE WEGRIA, GERHARD MUELHEIMS,2 JAMES R. GOLUB,3 ROBERT JREISSATY, AND JIRO NAKANO 4 (From the Department of Medicine, Columbia University College of Physicians and Surgeons, and the Presbyterian Hospital, New York, N. Y.) (Submitted for publication September 19, 1957; accepted November 21, 1957) In patients with aortic insufficiency and with- 10 ml. per kilogram of weight of a 1 per cent chloralose out disease of the coronary ostia or arteries, the solution. In the first four dogs the trachea, both com- of chest pain having some or many of mon carotid arteries and both external jugular veins occurrence were exposed through a midline incision and a Y-shaped the characteristics of cardiac pain due to myo- glass tube inserted into the trachea. Under artificial cardial ischemia has been ascribed classically to respiration, the left hemithorax was opened, the peri- a decrease in the coronary blood flow (1, 2), the cardium incised and the heart suspended in a peri- aortic insufficiency presumably decreasing the cardial cradle. The method used to measure and con- the mean aortic tinuously record the output of the left ventricle was a coronary blood flow by lowering modification of that previously described in this labora- diastolic pressure. However, the data available tory (6). The proximal ends of the left subclavian ar- on the effect of aortic insufficiency on the coronary tery and brachiocephalic trunk were cannulated. Then blood flow are contradictory. From acute ex- the aorta was clamped distally to the subclavian artery periments on the anesthestized dog, Green (3), so that the blood ejected by the left ventricle was di- as well as Green and Gregg (4), concluded that rected into an electromagnetic rotameter (7) and re- turned to the circulation via both carotid arteries can- when the aortic insufficiency is marked enough to nulated distally as well as both femoral arteries can- lower the aortic diastolic pressure, the increase nulated proximally and distally. Since the coronary in coronary blood flow occurring during systole sinus drains blood essentially only from the left coronary does not compensate for the decrease in flow dur- artery (8, 9) and since, in a given animal, the coronary and the mean coronary flow decreases. sinus blood flow represents a constant portion of the ing diastole left coronary artery flow (8), measurement of the coro- On the other hand, Foltz, Wendel, and West (5), nary sinus blood flow was used as a means of studying from measurements made on anesthetized dogs the left coronary artery blood flow. For that purpose, a in which one or two aortic cusps had been torn cannula was introduced via the left external jugular vein three or more days previously, concluded that the into the coronary sinus and tied in place by a string coronary blood flow was increased over levels passed around the coronary sinus. All the blood emerg- ing from the coronary sinus through this cannula was usually observed in normal dogs while oxygen directed into a second rotameter by means of which consumption was greatly increased over normal the coronary sinus blood flow was measured and con- levels. Because of the discrepancy in the opinions tinuously recorded. The coronary sinus blood was about the effect of aortic insufficiency on the coro- returned to the dog through a cannula introduced via the nary blood flow, it was thought advisable to rein- right external jugular vein down to the junction of the vestigate this problem. right auricle and the superior vena cava. Mean arterial blood pressure was recorded from the root of the aorta METHODS with a dampened Gregg manometer. Left ventricular output, mean aortic blood pressure and coronary sinus Eight dogs weighing between 17 and 40 kilograms blood flow were continuously recorded on photographic were anesthetized by the intravenous administration of paper. The heart rate was obtained by direct timing, 1 This work was made possible by grants-in-aid from from the blood pressure tracing or from an electro- the New York Heart Association, the Sidney A. Legendre cardiographic tracing. In the other four dogs the Gift and the Charles A. Frueauff Gift. output of the left ventricle was not measured and the 2 Postdoctorate Fellow of the United States Public coronary sinus flow was measured as in the first four Health Service. dogs. The mean femoral arterial blood pressure was $Fellow of the Dazian Foundation for Medical Re- recorded with a dampened Gregg manometer and the search. aortic pressure curve was recorded from the root of the 4 Research Fellow of the Hudson County (N. J.) aorta with another optical manometer. The instrument Heart Association. used to produce acute aortic insufficiency was the um- 471 472 R. WEGRIA, G. MUELHEIMS, J. R. GOLUB, R. JREISSATY, AND J. NAKANO TABLE I Effect of aortic insufficiency on heart rate, arterial blood pressure, cardiac output, coronary blood flow, coronary blood arteriovenous oxygen difference and cardiac oxygen consumption Duration Heart Arterial blood pressure Coronary Oxygen Exp. and of insuffi- rate Cardiac Coronary A-V 02 consump- dog no. ciency beat Mean Syst. Diast. output flow difference tion sec. min. mm. Hg mi./min. m./min. Vol. % ml./min. Aortic C.*. 136 150 1,220 59 15.5 9.2 1. A.I.t 235 160 135 830 80 15.4 12.4 R.t 152 140 1,000 57 15.9 9.1 C. 160 130 1,100 94 12.7 11.8 2. A.I. 316 160 110 960 113 13.4 15.1 R. 160 128 1,060 87 12.5 10.9 C. 167 97 810 49 15.8 7.7 3. A.I. 340 167 76 600 55 15.6 8.6 R. 176 94 675 50 15.5 7.7 C. 166 119 940 65 12.2 7.9 4. A.I. 214 170 105 940 78 12.7 9.9 R. 170 120 1,050 74 12.8 9.5 Femoral C. 160 120 38 17.3 6.6 5. A.I. 304 162 98 45 17.4 7.8 R. 162 110 40 17.9 7.2 Femoral Aortic Cl§ 144 132 157 116 68 16.2 11.0 A A.I.II 208 150 125 150 98 76 16.1 12.0 R, 146 132 148 114 68 16.2 11.0 C21 148 128 154 115 67 6.6 A.I.2 80 148 122 144 88 79 B A.I.8 155 150 117 145 80 80 7 C 4 210 150 118 148 76 85 A.I.5 277 150 108 141 63 87 R2 150 128 156 115 67 C, 183 128 140 105 61 14.9 9.1 A A.I.1 244 182 105 140 48 70 16.4 11.5 R, 185 128 140 105 61 14.9 9.1 7. C2 186 122 140 105 57 A.I.2 85 188 104 142 52 72 B A.I.s 243 188 104 145 64 72 A.I.4 348 188 104 142 64 70 R2 188 122 140 112 61 C, 112 160 183 132 65 21.1 13.7 A A.I., 126 140 128 154 55 83 21.5 17.8 R, 112 160 178 134 74 21.3 15.8 C2 112 158 182 125 62 A 30 120 139 172 86 81 8. *A.Las.I.2 83 122 156 172 95 72 A.I.4 130 132 138 176 96 77 B A.I.6 204 138 139 185 70 86 A.I.6 251 138 130 164 42 89 A.I.7 288 140 126 165 38 91 R2 138 160 180 120 68 * C., control. t A.I., aortic insufficiency. T R., recovery. § C1, control for part A. D A.I.,. 2 s, etc., aortic insufficiency of severity increasing or decreasing stepwise. C2, control for part B. AORTIC INSUFFICIENCY AND CORONARY CIRCULATION 473 brella type valve spreader previously described by Wig- gers and Maltby (10). While blood pressure, coronary 80 r-AORTIC BLOOD PRESSURE sinus blood flow and in some experiments left ventricu- lar output were being continuously recorded, the valve 160 H spreader was slipped into the aortic ring through the left 1- ventricular wall. The introduction of the instrument 140 into the aortic ring was without effect on blood pres- 120 1- CP sure, left ventricular output and coronary sinus flow. x Proper positioning of the instrument was judged by E I H0F palpation and the correctness of the position of the in- strument was checked by direct visualization at the end of each experiment. 80P In all eight experiments, after a control period an 60 k aortic insufficiency severe enough to lower definitely the mean and/or diastolic arterial blood pressure was in- 40 > duced and maintained from 126 to 340 seconds, after 90 -CORONARY BLLOOD FLOW which a period of recovery was observed. Arterial and coronary sinus blood samples were drawn simultane- 80 -\ ously at the end of the control period, the period of c aortic insufficiency and during the recovery period. The 70 _ oxygen content of the arterial and venous bloods was It> determined in duplicate by the method of Van Slyke and Neill (11). The oxygen consumption of that portion of the myocardium drained by the coronary sinus was cal- A.L A.
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