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

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

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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