The relation between the elevation of inflammatory mediators release and myocardial dysfunction after ischemia-reperfusion following Pringle's maneuver

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Hepatic resection is associated with a high incidence of adverse cardiac events. Patients with preoperative cardiac conditions appear to be at increased risk of early postoperative morbidity and mortality after hepatic resection. Although, Pringle's maneuver, total occulusion of the liver vasculature at the hepatoduodenal ligament, has been widely adopted to reduce bleeding during liver parenchymal dissection, it induced profound hepatic ischemia, which is considered to be potentially dangerous, especially to cirrhotic liver. In addition, ischemia-reperfusion injury following Pringle's maneuver leads to activation of inflammatory pathways, resulting in injury to distant organs such as the myocardium, lung, and kidney, which may initially dysfunction and eventually fail. Recently, proinflammatory cytokines have been implicated in mediating myocardial dysfunction. Hepatic resection with Pringle's maneuver is associated with a transient severe inflammatory response involving the release of proinflammatory cytokines and leads to systemic inflammation, which may be accompanied by cytokine-induced myocardial ventricular dysfunction.The aim of this study is to evaluate the perioperative alteration of myocardial, especially diastolic function by Tissue Doppler imaging (TDI) and whether this alteration is associated with a systemic response characterized by increased levels of inflammatory mediators in patients undergoing partial hepatectomy with Pringle's maneuver.In the present study, changes in myocardial velocities derived by using TDI indicated impairment in left ventricular systolic and diastolic performance after the first and last Pringle's maneuver. At the end of surgery, the systolic function returned to preoperative status, whereas the diastolic function remained deteriorated. In addition, the changes of LVEF and Sa were significantly correlated with the level of IL-6 after the last Pringle's maneuver.