Intraoperative Measurement of the Pulmonary Artery Pressure: Is It Reliable?

Document Type : Original Article

Authors

Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

Abstract

Background: Measurement of pulmonary artery pressure (PAP) is important for therapeutic planning in most types of structural heart diseases. The standard route for measuring PAP is cardiac catheterization. Nevertheless, in some cases, abnormal cardiac structures do not allow for advancing the catheter into the pulmonary artery. Measurement of pulmonary venous wedge pressure is another way, but it is not possible in some cases. During cardiac surgery, it is possible to measure PAP by directly entering a small needle into the pulmonary artery. This study aimed to evaluate the accuracy of PAP measurement during cardiac surgery in patients in a surgical environment.
 
Methods: The study enrolled 105 consecutive patients with congenital heart defects in whom cardiac catheterization was done before cardiac surgery. Systolic and diastolic pressures of the aorta and the pulmonary artery were measured and recorded both during catheterization and during cardiac surgery, and their correlations were assessed.
 
Results: Most of the pressures measured during cardiac surgery were lower than those measured during catheterization; nevertheless, no linear or other clear associations were found between them. There was no meaningful correlation concerning the amount of change between systemic and pulmonary pressures.
 
Conclusions: PAP significantly changes during general anesthesia and with an opened chest cage. PAP measured during surgery could not be relied upon for critical decisions such as univentricular approaches. (Iranian Heart Journal 2022; 23(1): 192-197)

Keywords


  1. Cetta F, Dearani J, O'Leary P, Driscoll D, Tricuspid Valve Disorders: Atresia, Dysplasia, and Ebstein Anomaly; in Allen H, Shaddy R, Penny D et al; Moss & Adams’ Heart Disease in Infants, Children, and Adolescents, Including the Fetus and Young Adult; 9th edition 2016, wolters Kluwer, 957-958
  2. van der Ven JPG, van den Bosch E, Bogers AJCC, Helbing WA. State of the art of the Fontan strategy for treatment of univentricular heart disease. F1000Res. 2018;7:F1000 Faculty Rev-935. Published 2018 Jun 27. doi:10.12688/f1000research.13792.1
  3. Hill KD, Janssen D, Ohmstede DP, Doyle TP. Pulmonary venous wedge pressure provides a safe and accurate estimate of pulmonary arterial pressure in children with shunt-dependent pulmonary blood flow. Catheter Cardiovasc Interv. 2009 Nov 1;74(5):747-52. doi: 10.1002/ccd.22084. PMID: 19496126.
  4. Earing M, Hagler D, Edwards W. Univentricular Atrioventricular Connection, in Allen H, Shaddy R, Penny D et al; Moss & Adams’ Heart Disease in Infants, Children, and Adolescents, Including the Fetus and Young Adult; 9th edition 2016, wolters Kluwer, 1235
  5. Akintoye, E., Veldtman, G.R., Miranda, W.R., Connolly, H.M. and Egbe, A.C. (2019), Optimum age for performing Fontan operation in patients with univentricular heart. Congenital Heart Disease, 14: 138-139. doi:10.1111/chd.12690
  6. Mohammad Nijres B, Murphy JJ, Diab K, Awad S, Abdulla R. Routine Cardiac Catheterization Prior to Fontan Operation: Is It a Necessity? Pediatric Cardiology. 2018 Apr 1;39(4):818-823. https://doi.org/10.1007/s00246-018-1825-8
  7. Arda Ozyuksel, Baran Simsek, Omer Ozden, et al. Fontan Procedure in Patients with Preoperative Mean Pulmonary Artery Pressure Over 15 mmHg. Authorea. September 05, 2020.
  8. Ohuchi H. Where Is the "Optimal" Fontan Hemodynamics?. Korean Circ J. 2017;47(6):842-857. doi:10.4070/kcj.2017.0105
  9. Parasuraman S, Walker S, Loudon BL, et al. Assessment of pulmonary artery pressure by echocardiography-A comprehensive review. Int J Cardiol Heart Vasc. 2016;12:45-51. Published 2016 Jul 4. doi:10.1016/j.ijcha.2016.05.011
  10. Melzig C, Wörz S, Egenlauf B, Partovi S, Rohr K, Grünig E, Kauczor HU, Heussel CP, Rengier F. Combined automated 3D volumetry by pulmonary CT angiography and echocardiography for detection of pulmonary hypertension. Eur Radiol. 2019 Nov;29(11):6059-6068. doi:10.1007/s00330-019-06188-7. Epub 2019 Apr 8. PMID: 30963276.
  11. Rengier F, Wörz S, Melzig C, Ley S, Fink C, Benjamin N, Partovi S, von Tengg-Kobligk H, Rohr K, Kauczor HU, Grünig E. Automated 3D Volumetry of the Pulmonary Arteries based on Magnetic Resonance Angiography Has Potential for Predicting Pulmonary Hypertension. PLoS One. 2016 Sep 14;11(9):e0162516. doi: 10.1371/journal.pone.0162516. PMID: 27626802; PMCID: PMC5023190.]
  12. Denault A, Deschamps A, Tardif JC, Lambert J, Perrault L. Pulmonary hypertension in cardiac surgery. Curr Cardiol Rev. 2010;6(1):1-14. doi:10.2174/157340310790231671
  13. Robitaille A, Denault AY, Couture P, Bélisle S, Fortier A, Guertin MC, Carrier M, Martineau R. Importance of relative pulmonary hypertension in cardiac surgery: the mean systemic-to-pulmonary artery pressure ratio. J Cardiothorac Vasc Anesth. 2006 Jun;20(3):331-9. doi: 10.1053/j.jvca.2005.11.018. Epub 2006 Apr 19. PMID: 16750732.