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Exercise ECGs are often valueless, as claudication may mask myocardial insufficiency. Myocardial performance was studied preoperatively in 29 consecutive patients undergoing elective aortic bifurcation grafting, using a Swann-Ganz catheter to measure the rise in pulmonary artery wedge pressure (PAWP) produced by rapid intravenous infusion of plasma (200\u2013400 ml). A Frank-Starling Curve was obtained by plotting LVSWI against PAWP. Two important values were obtained: (a) \u2018Upslope\u2019 or gradient of the ascending portion of the curve. Low values identify patients most at risk from cardiac complications. Six patients who suffered from postoperative cardiac complications had a mean \u2018upslope\u2019 value of 1\u00b7568 \u00b1 0\u00b7681 (1 s.e.m.), whereas the 23 who did not, had a mean value of 7\u00b7094 \u00b1 0\u00b7745 (1 s.e.m.), a significant difference (P &amp;lt; 0\u00b7001); (b) \u2018PAWPmax\u2019, the ventricular filling pressure above which work output dropped. Infusion beyond this may precipitate pulmonary oedema. PAWP was observed at levels greater than PAWPmax in all 6 patients who developed either pulmonary oedema or myocardial infarction. The myocardial performance curve can reliably identify high risk patients and permit control of intravenous therapy within individual safety limits, thereby preventing pulmonary oedema.<\/jats:p>","DOI":"10.1002\/bjs.1800700618","type":"journal-article","created":{"date-parts":[[2007,3,2]],"date-time":"2007-03-02T23:27:47Z","timestamp":1172878067000},"page":"362-364","source":"Crossref","is-referenced-by-count":5,"title":["Dynamic preoperative assessment of cardiac reserve in elective aortic surgery"],"prefix":"10.1093","volume":"70","author":[{"given":"D G","family":"Knight","sequence":"first","affiliation":[{"name":"Departments of Surgery and Anaesthetics, Ninewells Hospital and Medical School, University of Dundee , Dundee DD1 9SY,","place":["Scotland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B","family":"Lane","sequence":"additional","affiliation":[{"name":"Departments of Surgery and Anaesthetics, Ninewells Hospital and Medical School, University of Dundee , Dundee DD1 9SY,","place":["Scotland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S M","family":"McGowan","sequence":"additional","affiliation":[{"name":"Departments of Surgery and Anaesthetics, Ninewells Hospital and Medical School, University of Dundee , Dundee DD1 9SY,","place":["Scotland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M J","family":"Metcalf","sequence":"additional","affiliation":[{"name":"Departments of Surgery and Anaesthetics, Ninewells Hospital and Medical School, University of Dundee , Dundee DD1 9SY,","place":["Scotland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M G","family":"Walker","sequence":"additional","affiliation":[{"name":"Departments of Surgery and Anaesthetics, Ninewells Hospital and Medical School, University of Dundee , Dundee DD1 9SY,","place":["Scotland"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[1983,6,1]]},"reference":[{"key":"2024092714550483600_bib1","first-page":"405","article-title":"Resection of an aneursym of the abdominal aorta, re-establishment of continuity by a preserved human arterial graft","volume":"64","author":"Dubost","year":"1952","journal-title":"Arch. 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