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The Journal of Cardiovascular Surgery 2000 October;41(5):683-9

language: English

Direct intraoperative measurements of aortic and pulmonary blood flows in patients with severe pulmonary artery hypertension

Kitagawa T., Hori T., Chikugo F., Kawahito T., Kitaichi T., Fukuta Y., Fukumura Y., Matsuoka S. *, Katoh I.

From the Departments of Cardiovascular Surgery and *Pediatrics University of Tokushima School of Medicine Tokushima, Japan


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Background. Evaluate the sig­nif­i­cance of ­direct intra­op­er­a­tive meas­ure­ments of aor­tic and pul­mo­nary ­blood ­flows by elec­tro­mag­net­ic flow­me­ter as an abso­lute deci­sion ­basis for oper­abil­ity in ­patients ­with ven­tric­u­lar sep­tal ­defect/com­plete atri­o­ven­tric­u­lar sep­tal ­defect and ­severe pul­mo­nary ­artery hyper­ten­sion.
Methods. Experimental ­design: Pros­pec­tive ­study. Setting: Institutional prac­tice. Patients: Eight ­patients ­with mar­gi­nal oper­abil­ity ­based on pre­op­er­a­tive Doppler ech­o­car­di­og­ra­phy and car­diac cath­et­er­iza­tion (pul­mo­nary-to-system­ic ­flow ­ratio=1.1-2.3, pul­mo­nary-to-system­ic resis­tance ­ratio=0.34-0.91, and pul­mo­nary vas­cu­lar resis­tance=4.6-18.2 ­units·m2) under­went ­direct intra­op­er­a­tive meas­ure­ments of aor­tic and pul­mo­nary ­blood ­flows by elec­tro­mag­net­ic flow­me­ter. Operation ­would be per­formed accord­ing to the ­results of ­direct intra­op­er­a­tive meas­ure­ments in eve­ry ­patient.
Results. Aortic ­flow by ­direct intra­op­er­a­tive meas­ure­ments ­ranged ­from 0.9 to 3.2 L/min/m2, and pul­mo­nary ­blood ­flow ­from 4.1 to 8.4 L/min/m2. Pulmonary-to-aor­tic ­flow ­ratio was cal­cu­lat­ed at 2.1-6.6. Pulmonary vas­cu­lar resis­tance ­ranged ­from 2.6 to 7.7 ­units·m2. We ­assessed ­that all ­patients ­still had oper­abil­ity, and per­formed cor­rec­tive oper­a­tions. Postoperative cours­es cor­re­spond­ed ­with the ­data ­from the ­direct intra­op­er­a­tive meas­ure­ments.
Conclusions. When ­some clin­i­cal find­ings, par­tic­u­lar­ly Doppler echoc­ar­di­o­graph­ic find­ings, of ­these ­patients are slight­ly in ­favor of rever­sibil­ity of pul­mo­nary vas­cu­lar dis­ease ­despite dis­crep­ant ­data of pre­op­er­a­tive car­diac cath­et­er­iza­tion ­under a ­tight con­trol of car­bon diox­ide ten­sion, we rec­om­mend ­that ­direct intra­op­er­a­tive meas­ure­ment of aor­tic and pul­mo­nary ­blood ­flows is espe­cial­ly use­ful in deci­sion mak­ing for the oper­abil­ity of ­patients ­with ­severe pul­mo­nary ­artery hyper­ten­sion.

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