pituitrin and Heart-Valve-Diseases

The present study analyzes the hemodynamics of intracardiac occlusive periods during balloon mitral or aortic valvuloplasty and compares them with immediate plasma levels of atrial natriuretic factor (ANF), vasopressin and renin activity. Forty-nine patients were studied; 33 of them had mitral stenosis and 16 had aortic stenosis. The mean age was 52 +/- 17 years. During dilations pressures were monitored from the ascending aorta and left atrium. Plasma levels of ANF, vasopressin and renin were serially determined at baseline, after diagnostic procedures, within 15 to 30 seconds after the first 2 occlusive dilations, and 1 and 7 hours later. There were no significant changes in plasma renin throughout the study stages. ANF and vasopressin significantly increased after the dilations. These hormonal changes were related to the significant hemodynamic changes observed during intracardiac occlusion. The left atrial pressure correlated directly and significantly (r = 0.54, p less than 0.001) with plasma ANF levels throughout the conditions. On the other hand, the plasma vasopressin also correlated (r = 0.76, p less than 0.001) with systemic pressure in an exponential fashion. These findings show that abrupt releases of ANF and vasopressin occur immediately after intracardiac occlusive periods as a response to the acute and transient hemodynamic changes observed.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Aortic Valve; Atrial Natriuretic Factor; Blood Pressure; Catheterization; Child; Coronary Circulation; Female; Heart; Heart Valve Diseases; Homeostasis; Humans; Male; Middle Aged; Mitral Valve; Prospective Studies; Vasopressins

The hormonal responses to anaesthesia and cardiac surgery were studied in patients undergoing valve or coronary bypass surgery. Marked increases in antidiuretic hormone levels as a result of surgical stress were seen, and were of approximately equal magnitude in both groups. Although both groups also showed marked increases in plasma cortisol levels in response to operations, this response appeared to be relatively blunted in valve surgery patients, especially at the end of operation and in the intensive care unit. This blunted cortisol response may be a manifestation of exhaustion of adrenocortical reserves in valvular surgical patients whose sympathoadrenal system has already been chronically stimulated by a low output state. The important role of the neuroendocrine system in maintaining homeostasis postoperatively has long been recognized; this relative cortisol deficiency may be aetiologically related to poor postoperative recovery in critically ill valvular surgery patients.

Topics: Coronary Disease; Heart Valve Diseases; Hemodynamics; Humans; Hydrocortisone; Middle Aged; Stress, Physiological; Vasopressins

Topics: Adult; Aged; Aortic Valve; Cardiopulmonary Bypass; Coronary Artery Bypass; Coronary Disease; Electrolytes; Heart Valve Diseases; Hemodynamics; Humans; Male; Middle Aged; Mitral Valve; Osmolar Concentration; Urine; Vasopressins

Topics: Adult; Body Weight; Female; Glomerular Filtration Rate; Heart Valve Diseases; Heart Valve Prosthesis; Humans; Hydrocephalus; Hypertonic Solutions; Hyponatremia; Male; Osmolar Concentration; Sodium; Sodium Chloride; Vasopressins

Topics: Aorta; Blood Circulation; Blood Flow Velocity; Blood Pressure; Coronary Vessels; Dogs; Electrocardiography; Electromagnetic Phenomena; Electronics; Epinephrine; Heart; Heart Valve Diseases; Nitroglycerin; Norepinephrine; Pharmacology; Physical Exertion; Research; Vasopressins