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A Journal on Cardiac, Vascular and Thoracic Surgery

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The Journal of Cardiovascular Surgery 2003 December;44(6):719-24

language: English

Intrathoracic pulmonary artery catheter allocation in the background of left atrial dilatation

Tripathi M., Pandey M.

Depart­ment of Anaesthe­sio­logy and Crit­ical ­Care Med­i­cine, Sanjay ­Gandhi ­Post Grad­uate Insti­tute of Med­ical Sci­ences, ­Lucknow, ­India

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Aim. The aim of the ­study was to ­find out ­whether dil­a­ta­tion of the ­left ­atrium (LA) influ­ences the ­intra-tho­racic dis­tri­bu­tion of ther­mo­di­lu­tion pul­mo­nary ­artery (TPA) cath­eter in ­either ­branch of pul­mo­nary ­artery and com­pare the meas­ured car­diac ­output.
­Methods. In ­this pros­pec­tive ­study of 132 con­sec­u­tive ­patients in a uni­ver­sity hos­pital set­ting, LA ­size and ejec­tion frac­tion was ­assessed by ech­o­car­di­og­raphy, in the pre­op­er­a­tive ­period. In 66 ­patients ­posted for cor­o­nary ­artery ­bypass ­grafting (­Group 1), a stan­dard ­anaesthesia reg­imen was ­used and TPA cath­eter was ­floated ­through the ­right ­internal jug­ular. In ­another 66 ­patients of ­long-­standing ­mitral sten­osis for ­mitral ­valve ­repair/replace­ment (­Group 2), TPA cath­e­ters ­were sim­i­larly ­floated. Intra­tho­racic place­ment of the tip of the TPA cath­eter ­into the ­right or ­left pul­mo­nary ­artery (PA) was con­firmed on ­chest X-ray. TPA cath­eter ­length to its ­wedging, ­intra-arte­rial pres­sure, ­heart ­rate, PA pres­sure, pul­mo­nary ­artery ­wedge pres­sure (­PAWP) and car­diac ­output by ther­mo­di­lu­tion tech­nique ­were ­noted.
­Results. Left­wards TPA cath­eter place­ment was sig­nif­i­cantly (p<0.001) ­more fre­quent (71%) in ­mitral sten­osis ­patients (­group 2) ­than the ­CABG (­group 1), (18%). On ­regrouping the obser­va­tions of right­wards ­placed TPA (­Group R) and left­wards ­placed TPA (­Group L), we ­observed ­that ­large LA (≥25 mm3/m2) ­body sur­face ­area (BSA) and ­high ­PAWP (≥20 ­mmHg) was asso­ciated ­with sig­nif­i­cantly (p<0.001) ­higher inci­dence of left­wards TPA cath­e­ters. Pos­i­tive pre­dic­tive ­value of ­both the fac­tors in com­bi­na­tion was sig­nif­i­cantly ­higher (96%) ­than indi­vidual fac­tors ­large LA (81%) and ­high ­PAWP (88%).
Con­clu­sion. In ­long ­standing ­mitral sten­osis, ­left ­atrium enlarge­ment, ­with ­high ­PAWP and the hypo­ki­nesia of ­left ­atrium (­atrial fib­ril­la­tion) ­likely to influ­ence the angu­la­tion of ­left PA ­with ­main PA and so the pre­dom­i­nant ­entry of TPA cath­eter tip in ­left PA.

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