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, 主编.临床监测学.广州:广州科学技术出版社, 1997. 71-72.
2.	张宝仁, 主编.人造心脏瓣膜与瓣膜置换术.第2版.北京:人民卫生出版社, 1999. 274.
3.	韩林, 张宝仁, 朱家麟, 等.风湿性心脏病二尖瓣狭窄合并肺动脉高压者血管力学特性的变化.中华胸心外科学, 2001, 17(1):4-6.
4.	徐激斌, 张宝仁, 蔡凯华.风心病二尖瓣狭窄合并肺动脉高压的肺病理研究.第二军医大学学报, 1999, 12:997-999.
5.	方敏华, 张宝仁, 朱家麟, 等.风湿性心脏病患者心瓣膜置换术前后血浆肾上腺髓质素及肺血流动力学变化.中国胸心血管外科临床杂志, 2000, 7(1):1-3.
6.	胡小琴, 主编.心血管麻醉及体外循环.北京:人民卫生出版社, 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.	陈甬安.左房压和中心静脉压在低心排征治疗中的意义.现代实用医学, 2007, 19(11):883-884.
9.	葛翼鹏, 许建屏, 史艺, 等.心脏瓣膜手术后ICU时间延长的危险因素分析.中国胸心血管外科临床杂志, 2007, 14(2):85-88.
10.	丁凯, 周华富, 覃家锦, 等.心瓣膜置换术后患者围术期死亡原因分析.中国胸心血管外科临床杂志, 2011, 18(1):80-82.
11.	刘俊杰, 赵俊, 主编.现代麻醉学.第2版.北京:人民卫生出版杜, 1997. 765-768.
12.	陈锡明, 杭燕南, 主编.心血管功能监测.广州:广东科学技术出版社, 1997.1272.
13.	Ceyran H, Akçalý 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.	张日英, 邓劲松, 李波.经颈内静脉入路行左房压监测在复杂先心病矫治术中的临床应用.中国心血管病研究, 2011, 9(11):851-853.
15.	韩建阁, 寇党培, 赵彤, 等.中心静脉压与左房压联合监测在重症先心病婴幼儿围术期的应用.临床麻醉学杂志, 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, Oğuz 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, 李贞福, 王世端, 等.不同径路应用PGE1和PE治疗体外循环术后急性肺高压危象.国外医学:心血管疾病分册, 2001, 28(5):280-283.

1. 佘守章, 主编.临床监测学.广州:广州科学技术出版社, 1997. 71-72.
2. 张宝仁, 主编.人造心脏瓣膜与瓣膜置换术.第2版.北京:人民卫生出版社, 1999. 274.
3. 韩林, 张宝仁, 朱家麟, 等.风湿性心脏病二尖瓣狭窄合并肺动脉高压者血管力学特性的变化.中华胸心外科学, 2001, 17(1):4-6.
4. 徐激斌, 张宝仁, 蔡凯华.风心病二尖瓣狭窄合并肺动脉高压的肺病理研究.第二军医大学学报, 1999, 12:997-999.
5. 方敏华, 张宝仁, 朱家麟, 等.风湿性心脏病患者心瓣膜置换术前后血浆肾上腺髓质素及肺血流动力学变化.中国胸心血管外科临床杂志, 2000, 7(1):1-3.
6. 胡小琴, 主编.心血管麻醉及体外循环.北京:人民卫生出版社, 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. 陈甬安.左房压和中心静脉压在低心排征治疗中的意义.现代实用医学, 2007, 19(11):883-884.
9. 葛翼鹏, 许建屏, 史艺, 等.心脏瓣膜手术后ICU时间延长的危险因素分析.中国胸心血管外科临床杂志, 2007, 14(2):85-88.
10. 丁凯, 周华富, 覃家锦, 等.心瓣膜置换术后患者围术期死亡原因分析.中国胸心血管外科临床杂志, 2011, 18(1):80-82.
11. 刘俊杰, 赵俊, 主编.现代麻醉学.第2版.北京:人民卫生出版杜, 1997. 765-768.
12. 陈锡明, 杭燕南, 主编.心血管功能监测.广州:广东科学技术出版社, 1997.1272.
13. Ceyran H, Akçalý 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. 张日英, 邓劲松, 李波.经颈内静脉入路行左房压监测在复杂先心病矫治术中的临床应用.中国心血管病研究, 2011, 9(11):851-853.
15. 韩建阁, 寇党培, 赵彤, 等.中心静脉压与左房压联合监测在重症先心病婴幼儿围术期的应用.临床麻醉学杂志, 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, Oğuz 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, 李贞福, 王世端, 等.不同径路应用PGE1和PE治疗体外循环术后急性肺高压危象.国外医学:心血管疾病分册, 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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