Application of a transpulmonary double indicator dilution method for postoperative assessment of cardiac index, pulmonary vascular resistance index, and extravascular lung water in children undergoing total cavo-pulmonary anastomosis: preliminary results in six patients.
Total cavo-pulmonary anastomosis (TCPA) is used for the functional correction of an increasing spectrum of congenital heart diseases. The passive pulmonary perfusion after surgical exclusion of the right ventricle has significant implications for the postoperative hemodynamic management of these patients. Because conventional pulmonary artery thermodilution catheters present methodologic problems in patients after TCPA, important cardiovascular variables such as cardiac index (CI) and pulmonary and systemic vascular resistance indices (PVRI, SVRI) usually cannot be assessed directly. In a preliminary series of six patients undergoing TCPA (age 6-22 years), the applicability of a transpulmonary double indicator dilution technique for postoperative determinations of CI, PVRI, SVRI, and extravascular lung water (EVLW) was investigated. After central venous injection of ice-cold indocyanine green (5 mg), thermal and dye dilution curves were recorded in the abdominal aorta using a combined 4F fiberoptic thermistor catheter. Qualitative assessment of the tracer curves did not show major differences in measurements in patients with pulsatile perfusion of the lungs. CI, SVRI, and EVLW could be determined by use of standard algorithms. Pulmonary perfusion pressure for the calculation of PVRI was based on the gradient between central venous and left atrial pressure. The quality of indicator dilution curves allowed determination of flow-related variables in 33 of a total of 34 sets of measurements. No catheter-related problems occurred during or after the period of investigation. Postoperative EVLW was within the range that is commonly accepted as normal for adults. Mean PVRI initially decreased during the postoperative course but showed a significant increase after extubation.(ABSTRACT TRUNCATED AT 250 WORDS)
Weyland
A
A
Department of Anesthesiology, University of Göttingen, Germany.
Buhre
W
W
Hoeft
A
A
Wietasch
G
G
Ruschewski
W
W
Allgeier
B
B
Schorn
B
B
Sonntag
H
H
D000328:Adult; D000465:Algorithms; D000714:Anastomosis, Surgical / Q000379:methods*; D001012:Aorta, Abdominal / Q000502:physiology; D016279:Atrial Function, Left / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D002302:Cardiac Output / Q000502:physiology*; D002404:Catheterization; D002496:Central Venous Pressure / Q000502:physiology; D002648:Child; D015633:Extravascular Lung Water / Q000502:physiology*; D006330:Heart Defects, Congenital / Q000601:surgery; D006801:Humans; D007201:Indicator Dilution Techniques; D007208:Indocyanine Green; D011182:Postoperative Care; D011651:Pulmonary Artery / Q000502:physiology* / Q000601:surgery*; D011673:Pulsatile Flow / Q000502:physiology; D014655:Vascular Resistance / Q000502:physiology*; D014683:Vena Cava, Superior / Q000601:surgery*
D007208:Indocyanine Green