Hemodynamic consequences of afterload reduction in patients with chronic aortic regurgitation

SUMMARY Nitroprusside was used to reduce afterload in 13 patients with isolated, severe aortic regurgitation. The drug significantly lowered mean aortic pressure, pulse pressure, left ven-tricular end-diastolic pressure and left ventricular volume. Total ven-tricular, or angiographic, cardiac index was generally unaffected, but forward cardiac index was improved significantly in 8 of 13 patients. Augmentation of forward cardiac index was seen in patients with sub-normal resting forward cardiac index, in patients with decidedly elevated end-diastolic pressure, and in those with depressed resting NITROPRUSSIDE has significant and favorable effects upon hemodynamics in patients with mitral regurgita-tion," ' 2 acute myocardial infarction,3 and chronic ischemic heart disease.4 In mitral regurgitation, the benefit arises primarily by reducing regurgitant volume and pulmonary venous pressure and by increasing forward cardiac out