HAEMODYNAMIC EFFECTS OF DOPAMINE AND DOPAMINE COMBINED WITH NITROGLYCERIN IN PATIENTS SUBJECTED TO CORONARY BYPASS SURGERY

The haemodynamic effects of dopamine and dopamine with nitroglycerin were evaluated in eight patients with coronary heart disease who underwent aortocoronary bypass surgery. The study was performed under anaesthesia and before surgery. Dopamine 8 (ig kg"1 min"1 alone produced a marked increase of the cardiac index from 2.47 to 3.47 litre min"1 m~2 but only small changes in heart rate (from 65 to 68 beat min"1). This improvement in cardiac performance was accompanied by an increase of the mean pulmonary artery pressure from 10.9 to 21.3 mm Hg and in the left ventricular filling pressure from 6.1 to 13.8 mm Hg with unchanged systemic and pulmonary vascular resistance. Mean arterial pressure increased from 72 to 103 mm Hg. Simultaneous infusion of dopamine (8 jig kg"1 min"1) and nitroglycerin (mean dose 0.5 ng kg"1 min"1) resulted in a favourable reduction of mean pulmonary artery pressure (from 21.3 to 14.4 mm Hg) and of left ventricular filling pressure (from 13.8 to 7.9 mm Hg). Cardiac index (from 3.47 to 3.34 litre min-1 m~2) and mean arterial pressure (from 103 to 95 mm Hg) were not reduced to the same extent by the addition of nitroglycerin. The combined treatment of dopamine with nitroglycerin seems to be of value in patients with pre-existing high left ventricular filling pressure or with pulmonary hypertension