Assessment of myocardial performance with ventricular pressure-volume relations: clinical applications in cardiac surgery

The assessment of myocardial performance in patients with cardiomyopathy is of vital importance in cardiology and cardiac surgery, especially considering the significant increase in the number of patients treated for congestive heart failure. Left ventricular pressure-volume analysis is a method, which can assess accurately myocardial contractility, separating the systolic and diastolic function at different preload and afterload conditions. This technique can be used for determination of the efficacy of a therapeutic pharmaceutical or surgical intervention, for instance the assessment of ventricular function after coronary revascularization. A few studies using the conductance catheter for the analysis of ventricular pressure-volume relations in the field of cardiac surgery have been published. In our center we started to use this technique to analyze cardiac surgical procedures, like mitral valve reconstruction, aortic valve replacement, myocardial revascularization, left ventricular assist, and surgical left ventricular remodeling. This information will be used to develop a therapeutic strategy, which may optimize surgical indications and improve the peri- and postoperative treatment and the efficacy of that surgical technique. In this short review the possible clinical use in cardiac surgery and the methodology of the pressure-volume loops have been described. Three clinical cases are presented to demonstrate functional information related to the surgical treatment of congestive heart failure patients.