Improved cardiac function in patients with obstructive jaundice after internal biliary drainage: hemodynamic and hormonal assessment

Abstract

Objective: To investigate myocardial function in patients with obstructive jaundice before and after internal biliary drainage.

Summary background data: Increased plasma levels of atrial natriuretic peptide (ANP) have been found in patients with biliary obstruction.

Methods: Thirteen patients with newly diagnosed obstructive jaundice and no previous heart, lung, or renal disease were studied using a Swan-Ganz catheter. Hemodynamic measurements were taken before and 4 days after internal biliary drainage. Levels of ANP and brain natriuretic peptide (BNP) were obtained and liver function tests were also determined.

Results: Plasma levels of ANP and BNP were increased twofold to fourfold in the basal state and declined after biliary drainage. Independent variables predicting left ventricular systolic work were total bilirubin concentrations, duration of jaundice, and BNP. In addition, bilirubin concentrations correlated with pulmonary vascular resistance, mean arterial pulmonary pressure, and right ventricular systolic work. Internal biliary drainage resulted in an improvement in left ventricular systolic work. A correlation was found between decreasing ANP concentrations and increasing cardiac output.

Conclusions: Increased plasma levels of natriuretic peptides in patients with obstructive jaundice may reflect a subclinical myocardial dysfunction correlating with the degree of jaundice. After internal biliary drainage, there is a measurable improvement of cardiac function.

Figures

Figure 1. Correlation between basal plasma concentrations of total bilirubin and left ventricular systolic work in patients with newly diagnosed obstructive jaundice.

Figure 2. Correlation between changes in cardiac output and plasma concentrations of atrial natriuretic peptide after internal biliary drainage.