A Comparison of Tissue Doppler Echocardiography and B-Type Natriuretic Peptide in Estimating Pulmonary Capillary Wedge Pressure

BACKGROUND: There are several echocardiographic parameters, such as early transmitral velocity/tissue Doppler mitral annular early diastolic velocity(E/Ea) or deceleration time, reported to be reliable indices to estimate pulmonary capillary wedge pressure(PCWP). Recently, B-type natriuretic peptide(BNP) level is also reported to increase in accordance with increased left ventricular filling pressure in systolic or diastolic heart failure. This study was performed to compare E/Ea and BNP for the ability to estimate PCWP. METHODS: Several echocardiographic Doppler parameters including especially E/Ea were obtained from transthoracic Doppler echocardiography. Simultaneously, serum BNP level and PCWP estimated by using Swan-Ganz catheter were obtained, respectively. RESULTS: E/Ea revealed a correlation of r=0.88 (p or =11 was the optimal cutoff to predict PCWP > or =15 mmHg (sensitivity, 94%; specificity, 90%), whereas the optimal BNP cutoff was > or =250 pg/mL (sensitivity, 52%; specificity, 74%). CONCLUSION: Mitral E/Ea has a better correlation with PCWP than BNP. Mitral E/Ea appears more sensitive and specific than BNP for PCWP > or =15 mmHg in cardiac patients.

A Comparison of Hemodynamic Indices Derived by Invasive Monitoring and Transesophageal Echocardiography in Patients with Aortic Stenosis / 대한마취과학회지

BACKGROUND: Intraoperative fluid management should be aimed at maintaining appropriate left-sided filling pressures. The pulmonary capillary wedge pressure (PCWP) will overestimate the left ventricular end-diastolic volume (LVEDV) when ventricular compliance is markedly reduced in patients with aortic stenosis. Intraoperative transesophageal echocardiography (TEE) is useful for monitoring global left ventricular function and change of preload. This study was undertaken to evaluate preload derived by conventional invasive monitoring technique compare with preload obtained simultaneously from TEE in patients with aortic stenosis. METHODS: Fifteen patients with aortic stenosis who underwent aortic valve replacement were examined. The preload was examined by the short axis view of left ventricle with TEE at the level of the papillary muscles. For each patient, simultaneous measurements of PCWP, thermodilution cardiac output and left ventricular end-diastolic area (LVEDA) measured by TEE were made after the induction of anesthesia and after surgery. RESULTS: The correlation between echo-derived LVEDA and thermodilution cardiac index (CI) (r=0.53, p<0.05) or stroke index (SI) (r=0.56, p<0.05) was good after surgery, but the correlation was not found after induction of anesthesia. No correlation was observed between PCWP and CI or SI. CONCLUSIONS: The PCWP did not provide a reliable estimate of preload and did not allow good prediction of cardiac index. These findings demonstrate that, in patients with aortic stenosis who underwent aortic valve replacement, TEE provides a better index of left ventricular preload than conventional invasive hemodynamic monitoring particularly after surgery.

Comparison of Central Venous Pressure, Diastolic Pulmonary Artery Pressure and Pulmonary Capillary Wedge Pressure and Pulmonary Capillary Wedge Pressure as Estimates of Left Atrial Pressure / 대한마취과학회지

BACKGROUND: To evaluate the left heart function, left atrial pressure(LAP) has been monitored directly via LA catheter and indirectly via Swan-Ganz catheter. But indirect pressure monitor cannot often reflect the LAP precisely. We compared the LAP via LA catheter with central venous pressure(CVP), diastolic pulmonary artery pressure(DPAP) and pulmonary capillary wedge pressure(PCWP) by Swan-Ganz catheter. METHODS: Eleven cardiac-surgical patients whose LAP measurements were needed for clinical management were the subjects of this study. The CVP, DPAP and PCWP by Swan-Ganz catheter, and LAP were measured just after cardiopulmonary bypass, just after sternal closure, after 6 hours and 18 hours from the end of operation. And we divided them into two groups which consisted below 35 mmHg(group I) and over 35 mmHg(group II) of systolic pulmonary artery pressure(SPAP), and compared two groups. RESULTS: In group I, the LAP, CVP, DPAP and PCWP was 11.7+/-3.9 mmHg, 10.5+/-3.9 mmHg, 12.5+/-5.1 mmHg and 12.5+/-4.4 mmHg respectively, and correlation coefficiency of LAP with CVP, DPAP and PCWP was 0.7478, 0.7128 and 0.9002 respectively(p<0.05). In the group II, the LAP, CVP, DPAP and PCWP was 16.5+/-3.2 mmHg, 12.8+/-2.9 mmHg, 23.4+/-3.8 mmHg and 20.8+/-4.7 mmHg respectively and there was no correlation between LAP, CVP, DPAP and PCWP. CONCLUSIONS: The Swan-Ganz catheterization for the estimation of LAP is useful in the patients without pulmonary hypertension, but in the patient with pulmonary hypertension, CVP, DPAP and PCWP do not reflect the LAP.

Comparison of Central Venous Pressure, Diastolic Pulmonary Artery Pressure and Pulmonary Capillary Wedge Pressure and Pulmonary Capillary Wedge Pressure as Estimates of Left Atrial Pressure / 대한마취과학회지

BACKGROUND: To evaluate the left heart function, left atrial pressure(LAP) has been monitored directly via LA catheter and indirectly via Swan-Ganz catheter. But indirect pressure monitor cannot often reflect the LAP precisely. We compared the LAP via LA catheter with central venous pressure(CVP), diastolic pulmonary artery pressure(DPAP) and pulmonary capillary wedge pressure(PCWP) by Swan-Ganz catheter. METHODS: Eleven cardiac-surgical patients whose LAP measurements were needed for clinical management were the subjects of this study. The CVP, DPAP and PCWP by Swan-Ganz catheter, and LAP were measured just after cardiopulmonary bypass, just after sternal closure, after 6 hours and 18 hours from the end of operation. And we divided them into two groups which consisted below 35 mmHg(group I) and over 35 mmHg(group II) of systolic pulmonary artery pressure(SPAP), and compared two groups. RESULTS: In group I, the LAP, CVP, DPAP and PCWP was 11.7+/-3.9 mmHg, 10.5+/-3.9 mmHg, 12.5+/-5.1 mmHg and 12.5+/-4.4 mmHg respectively, and correlation coefficiency of LAP with CVP, DPAP and PCWP was 0.7478, 0.7128 and 0.9002 respectively(p<0.05). In the group II, the LAP, CVP, DPAP and PCWP was 16.5+/-3.2 mmHg, 12.8+/-2.9 mmHg, 23.4+/-3.8 mmHg and 20.8+/-4.7 mmHg respectively and there was no correlation between LAP, CVP, DPAP and PCWP. CONCLUSIONS: The Swan-Ganz catheterization for the estimation of LAP is useful in the patients without pulmonary hypertension, but in the patient with pulmonary hypertension, CVP, DPAP and PCWP do not reflect the LAP.

The Relationship Between Central Venous Pressure and Pulmonary Capillary Wedge Pressure in Patients with Aortic Stenosis / 대한마취과학회지

BACKGROUND: Hemodynamic monitoring during aortic valve replacement in patients with aortic stenosis is controversial and there are little prospective data on which to base an enlightened clinical decision. The relationship between central venous pressure (CVP) and pulmonary capillary wedge pressure (PCWP) was examined in patients with aortic stenosis. METHODS: 30 patients with aortic stenosis who underwent aortic valve replacement were examined. For each patient, simultaneous measurements of CVP, pulmonary artery diastolic pressure (PADP) and PCWP were made at pre-and post-cardiopulmonary bypass. After cardiopulmonary bypass, measurement of left atrial pressure(LAP) was made. RESULTS: The PCWP correlated well with PADP(r=0.86 p0.05, r=0.45 p>0.05), PCWP(r=0.39 p0.05, r=0.51 p<0.05). CONCLUSIONS: This study confirmed the disparities between CVP and PCWP which were anticipated in aortic stenosis. This disparity seems due to marked differences between either compliance or function of the two ventricles. Therefore, CVP monitoring in aortic stenosis is limited value and may mislead in management.

Measurement of Right Ventricular Ejection Fraction(RVEF) in Patients Undergoing Cardiac Surgery / 대한마취과학회지

The left ventricle is realized as the cardiac structure of greatest importance for cardiac pump function, and the role of the right ventricle has been overlooked. However, the right ventricle and the left ventricle are in series and physiologically coupled so that a disturbance in the one ventricular function will influence the behavior of the other. Thus, there ia growing interest in the importance of the right side of the heart, particularly in patients undergoing cardiac surgery. Moreover recently, right ventricular failure has been identified as a cause of progressive deterioration in patients undergoing cardiac operations, and it may limit the overall success of the procedure. This study was performed to investigate right ventricular ejection fraction of the cardiac patients at pre and post-perfusion period. 10 cases were measured and analyzed. The results were as follows: I) There were no singificant differences statistically in demographic data of the patients. 2) Pulmonary capillary wedge pressure(PCWP) of postperfusion 10 min. was significantly increased compared to preperfusion period(p<0.01). 3) Systemic vascular resistance(SVR) of immediate postperfusion period was significantly decreased compared to preperfusion period. 4) Heart rate and central venous pressure(CVP) of postperfusion period were statistically significantly increased, but clinically no significant change compared to preperfusion period. 5) Cardiac output(CO) and right ventricular ejection fraction(RVEF) of postperfusion period were no significant change compared to preperfusion period.

A Case of Pulmonary Edema Developed during Cesarean Section in a Patient with Servere Preeclapmsia / 대한마취과학회지

Preeclampsia continues to represent a significant cause of morbidity and mortality in 5-10% of all pregnancies. The pathophysiology of preeclampsia can involve virtually every organ system, and in extreme cases cardiac decompensation may occur. Single epidural anesthesia for Cesarean section was performed in a patient with severe preeclampsia who already had clinical evidence of pulmonary congestion. A balanced salt solution was administered rapidly to prevent hypotension resulting from the epidural block. She started complaining of severe dizziness around 10 minutes after epidural injection of 18 ml bupivacaine. General anesthesia was substituted for epidural anesthesia because of inadequate analgesia for the operation. Chest rales and frothy sputum through the endotracheal tube were noticed to the patient and she remained unconscious after the operaion was finished. The chest X-ray revealed pulmonary edema but the brain computed tomographic scan was unremarkable. She was treated in the intensive care unit using a respirator with PEEP therapy and vasodilators. She was rapidly recovered from unconsciousness with cardiovascular instability. It was suggested that rapid hydration was one of the main contributing factors causing pulomanary edema in this patient with severe preeclampsia. The pulmonary edema possibly could be prevented by monitoring of pulmonary capillary wedge pressure with careful Swan-Ganze catheterization.

EFFECT OF O-METHYLDAURICINE ON ECG AND HAE-MODYNAMICS IN ANAESTHETIZED DOGS / 中国药理学通报

The effects of o-methyldauricine ( OMD ) , a derivative of dau-ricine, 2.5 & 5 nig/kg given intravenously on ECG & haemodyna-mics were studied in 14 anaesthetized dogs.OMD significantly decreased systolic & diastolic blood pressure dose-dependently, accompanied by a decrease in total peripheral resistance, an increase in strok volume & a slight increase in PEP/LVET. These haemodynamic effects are similar to those of dauricine. It produced a decrease in heart rate & no changes of mean pulmonary artery pressure & pulmonary capillary wedge pressure. 2.5mg/kg of OMD did not influence ECG significantly; 5 mg/kg of that slightly prolonged PR interval & did not alter QRS width & QTc interval significantly. Comparing with the results reported previously about dauricine the data suggest that OMD is similar to dauricine in hypotensive effect & different in effects on ECG from dauricine that prolonged PR interval & QRS width significantly.