STUDYING THE EFFECT OF lARGE VOLUME ABDOMINAL PARACENTESIS ON CARDIAC PERFORMANCE IN PATIENTS WITH LIVER CIRRHOSIS AND TENSE ASCITES

Abstract

Tense ascites is one of the most disabling and distressing complication of liver cirrhosis. Cirrhosis is associated with cardiovascular abnormalities, in the presence of ascites, these abnormalities is more marked presumably because of increased intrathoracic pressure and bulging of the diaphragm induced by fluid accumulation.

To assess these alterations in ventricular function, fifty cirrhotic patiems with tense ascites and were investigated by echo-Doppler along with neurohumoral variables. All measurements were repeated immediately after large 'olume abdominal paracentesis.

Plasma aldosterone, plasma renin activity, plasma norepinephrine and plasma epinephrine were significantly and markedly greater in ci hotic patients with tense ascites. Neurohormonal overactivity, known to stimulate cardiac tissue growth. may challenge the heart, promoting fibrosis and exerting a further hindrance to ventricular relaxation.

Cirrhotic patients with tense ascites experienced impaired left ventricular diastolic function. The impairment manifested as non significant increase of E wave velocity, significant increase of A wave velocity, highly significant reduction of E/A ratio, significant prolongation in D- time of E.

Paracentesis induced a reduction of the highly increased basal plasma renin activity, aldosterone, norepinephrine and epinephrine and improved the diastolic function; however, the systolic function was unaffected