Improved Cardiac Function in Patients With Obstructive Jaundice After Internal Biliary Drainage: Hemodynamic and Hormonal Assessment

Hypotension and renal failure are well-known complications in patients with obstructive jaundice (OJ) undergoing surgery or experiencing an infection. In 1960, Williams et al 1 showed that the volume of blood that had to be withdrawn from animals with OJ to produce shock was significantly less than in normal controls. Dawson 2 drew attention to the increasing problem of renal failure in patients undergoing surgery for OJ, and suggested that preoperative infusion of mannitol could prevent postoperative renal dysfunction. The use of mannitol infusion, however, has not been validated by prospective studies, 3 and emphasis has been placed on extracellular fluid depletion 4,5 and myocardial dysfunction 6 as causes of hemodynamic disturbances in patients with OJ. Experimental and human studies 7–9 have shown that obstruction of the biliary tract is associated with elevated plasma concentrations of the atrial natriuretic peptide (ANP). These occur despite the moderate volume depletion that is a hallmark of OJ. 4,9 In experimental studies, the most probable origin of increased ANP concentrations was found to be the heart. 8,10 Further investigations showed that increased plasma ANP concentrations return to normal bile flow is restored. 9,11 We conducted this study to investigate whether cardiac function correlates with liver function test results in patients with OJ and whether decreasing ANP concentrations after biliary drainage reflect an improvement of cardiac function. 12,13 Brain natriuretic peptide (BNP) plasma concentrations were also investigated because recent data suggest that they may be a better marker of heart failure development than ANP. 14