Left Atrial Pressure and Pulmonary Artery Wedge Pressure Monitoring in Patients after Cardiac Surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 WEIYu , RENHai-bo , LIUBin , XUWei-jiang

Intensive Care Unit, Wuhan Asia Heart Hospital, Wuhan 430022, P. R. China;

Corresponding?author：

WEIYu, Email: lilyw1223@aliyun.com

Keywords：

Left atrial pressure; Pulmonary artery wedge pressure; Cardiac surgery

DOI：

10.7507/1007-4848.20140221

Video：

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Objective To investigate the feasibility, safety and accuracy of inserting a left atrial piezometer tube and pulmonary artery flotation catheter (PAFC)via the internal jugular vein (IJV)for postoperative monitoring of adult patients with pulmonary arterial hypertension (PAH)after open cardiac surgery. Methods A prospective study was conducted in 100 patients aged over 18 years who underwent open cardiac surgery in Wuhan Asia Heart Hospital from 2010 to 2012. There were 43 male and 57 female patients with their age of 46-65 (47±16)years. All the patients were divided into 2 groups, including 50 patients with severe PAH who underwent heart valve replacement (HVR)in group A, and 50 patients with mild to moderate PAH who underwent HVR in group B. All the patients received insertion of ARROW 5 Fr three-cavity catheter by piercing the atrial septum via IJV for continuous monitoring of left atrial pressure (LAP), and insertion of ARROW 8 Fr high-flow sheath for PAFC implantation via IJV in the same side. LAP and pulmonary artery wedge pressure (PAWP)were continuously monitored after the patients entering the intensive care unit (ICU). The corelation and accuracy of LAP and PAWP were observed in the 2 groups. Results All the patients successfully received continuous LAP and PAWP monitoring without serious catheter-related complications. There was no statistical difference in operation time or extracorporeal circulation time between group A and B (P > 0.05). There was statistical difference in postoperative mechanical ventilation time and length of ICU stay between the 2 groups (P < 0.05). Mean pulmonary artery pressure (PAP_mean), mean LAP (LAP_mean), mean PAWP (PAWP_mean), and mean difference between PAWP and LAP (PAWP-LAP_mean)of group A were significantly higher than those of group B (P < 0.01). PAWP was well correlated with LAP in both groups, and the correlation in group A was significantly milder than that in group B (P < 0.01). Conclusion It is safe and feasible for LAP and PAFC monitoring via IJV after cardiac surgery. PAWP can not accurately reflect left ventricular preload, and LAP is more accurate to monitor left ventricular preload for patients with severe PAH.

Citation： WEIYu, RENHai-bo, LIUBin, XUWei-jiang. Left Atrial Pressure and Pulmonary Artery Wedge Pressure Monitoring in Patients after Cardiac Surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(6): 770-773. doi: 10.7507/1007-4848.20140221 Copy

1.	佘守章, 主編.臨床監測學.廣州:廣州科學技術出版社, 1997. 71-72.
2.	張寶仁, 主編.人造心臟瓣膜與瓣膜置換術.第2版.北京:人民衛生出版社, 1999. 274.
3.	韓林, 張寶仁, 朱家麟, 等.風濕性心臟病二尖瓣狹窄合并肺動脈高壓者血管力學特性的變化.中華胸心外科學, 2001, 17(1):4-6.
4.	徐激斌, 張寶仁, 蔡凱華.風心病二尖瓣狹窄合并肺動脈高壓的肺病理研究.第二軍醫大學學報, 1999, 12:997-999.
5.	方敏華, 張寶仁, 朱家麟, 等.風濕性心臟病患者心瓣膜置換術前后血漿腎上腺髓質素及肺血流動力學變化.中國胸心血管外科臨床雜志, 2000, 7(1):1-3.
6.	胡小琴, 主編.心血管麻醉及體外循環.北京:人民衛生出版社, 1997.946-950.
7.	Hildick-Smith DJ, Walsh JT, Shapiro LM. Pulmonary capillary wedge pressure in mitral stenosis accurately reflects mean left atrial pressure but overestimates transmitral gradient. Am J Cardiol, 2000, 85(4):512-515, A11.
8.	陳甬安.左房壓和中心靜脈壓在低心排征治療中的意義.現代實用醫學, 2007, 19(11):883-884.
9.	葛翼鵬, 許建屏, 史藝, 等.心臟瓣膜手術后ICU時間延長的危險因素分析.中國胸心血管外科臨床雜志, 2007, 14(2):85-88.
10.	丁凱, 周華富, 覃家錦, 等.心瓣膜置換術后患者圍術期死亡原因分析.中國胸心血管外科臨床雜志, 2011, 18(1):80-82.
11.	劉俊杰, 趙俊, 主編.現代麻醉學.第2版.北京:人民衛生出版杜, 1997. 765-768.
12.	陳錫明, 杭燕南, 主編.心血管功能監測.廣州:廣東科學技術出版社, 1997.1272.
13.	Ceyran H, Ak?aly Y, Asgun F, et al. Benefit of using a triple-lumen catheter to monitor left atrial pressure. Acta Anaesthesiol Scand, 2003, 47(4):430-432.
14.	張日英, 鄧勁松, 李波.經頸內靜脈入路行左房壓監測在復雜先心病矯治術中的臨床應用.中國心血管病研究, 2011, 9(11):851-853.
15.	韓建閣, 寇黨培, 趙彤, 等.中心靜脈壓與左房壓聯合監測在重癥先心病嬰幼兒圍術期的應用.臨床麻醉學雜志, 2002, 18(9):491.
16.	Neema PK, Neelakandhan KS, Waikar HD. Continuous direct left atrial pressure monitoring during closed mitral commissurotomy. J Cardiothorac Vasc Anesth, 1995, 9(6):786-787.
17.	Aral A, O?uz M, Ozberrak H, et al. Hemodynamic advantages of left atrial epinephrine administration in open heart operations. Ann Thorac Surg, 1997, 64(4):1046-1049.
18.	Zahorec R, Holoman M. Transatrial access for left atrial pressure monitoring in cardiac surgery patients. Eur J Cardiothorac Surg, 1997, 11(2):379-780.
19.	Tkachenko BI, Evlakhov VI, Poyasov IZ. Dynamic relations between right and left atrial pressure shifts induced by catecholamines. Bull Exp Biol Med, 2005, 139(1):1-3.
20.	邢泉生, 李貞福, 王世端, 等.不同徑路應用PGE1和PE治療體外循環術后急性肺高壓危象.國外醫學:心血管疾病分冊, 2001, 28(5):280-283.

1. 佘守章, 主編.臨床監測學.廣州:廣州科學技術出版社, 1997. 71-72.
2. 張寶仁, 主編.人造心臟瓣膜與瓣膜置換術.第2版.北京:人民衛生出版社, 1999. 274.
3. 韓林, 張寶仁, 朱家麟, 等.風濕性心臟病二尖瓣狹窄合并肺動脈高壓者血管力學特性的變化.中華胸心外科學, 2001, 17(1):4-6.
4. 徐激斌, 張寶仁, 蔡凱華.風心病二尖瓣狹窄合并肺動脈高壓的肺病理研究.第二軍醫大學學報, 1999, 12:997-999.
5. 方敏華, 張寶仁, 朱家麟, 等.風濕性心臟病患者心瓣膜置換術前后血漿腎上腺髓質素及肺血流動力學變化.中國胸心血管外科臨床雜志, 2000, 7(1):1-3.
6. 胡小琴, 主編.心血管麻醉及體外循環.北京:人民衛生出版社, 1997.946-950.
7. Hildick-Smith DJ, Walsh JT, Shapiro LM. Pulmonary capillary wedge pressure in mitral stenosis accurately reflects mean left atrial pressure but overestimates transmitral gradient. Am J Cardiol, 2000, 85(4):512-515, A11.
8. 陳甬安.左房壓和中心靜脈壓在低心排征治療中的意義.現代實用醫學, 2007, 19(11):883-884.
9. 葛翼鵬, 許建屏, 史藝, 等.心臟瓣膜手術后ICU時間延長的危險因素分析.中國胸心血管外科臨床雜志, 2007, 14(2):85-88.
10. 丁凱, 周華富, 覃家錦, 等.心瓣膜置換術后患者圍術期死亡原因分析.中國胸心血管外科臨床雜志, 2011, 18(1):80-82.
11. 劉俊杰, 趙俊, 主編.現代麻醉學.第2版.北京:人民衛生出版杜, 1997. 765-768.
12. 陳錫明, 杭燕南, 主編.心血管功能監測.廣州:廣東科學技術出版社, 1997.1272.
13. Ceyran H, Ak?aly Y, Asgun F, et al. Benefit of using a triple-lumen catheter to monitor left atrial pressure. Acta Anaesthesiol Scand, 2003, 47(4):430-432.
14. 張日英, 鄧勁松, 李波.經頸內靜脈入路行左房壓監測在復雜先心病矯治術中的臨床應用.中國心血管病研究, 2011, 9(11):851-853.
15. 韓建閣, 寇黨培, 趙彤, 等.中心靜脈壓與左房壓聯合監測在重癥先心病嬰幼兒圍術期的應用.臨床麻醉學雜志, 2002, 18(9):491.
16. Neema PK, Neelakandhan KS, Waikar HD. Continuous direct left atrial pressure monitoring during closed mitral commissurotomy. J Cardiothorac Vasc Anesth, 1995, 9(6):786-787.
17. Aral A, O?uz M, Ozberrak H, et al. Hemodynamic advantages of left atrial epinephrine administration in open heart operations. Ann Thorac Surg, 1997, 64(4):1046-1049.
18. Zahorec R, Holoman M. Transatrial access for left atrial pressure monitoring in cardiac surgery patients. Eur J Cardiothorac Surg, 1997, 11(2):379-780.
19. Tkachenko BI, Evlakhov VI, Poyasov IZ. Dynamic relations between right and left atrial pressure shifts induced by catecholamines. Bull Exp Biol Med, 2005, 139(1):1-3.
20. 邢泉生, 李貞福, 王世端, 等.不同徑路應用PGE1和PE治療體外循環術后急性肺高壓危象.國外醫學:心血管疾病分冊, 2001, 28(5):280-283.

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Left Atrial Pressure and Pulmonary Artery Wedge Pressure Monitoring in Patients after Cardiac Surgery

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