title: Monitoring pulmonary artery pressure in children undergoing the Fontan procedure.
abstract: OBJECTIVE
  To compare external and internal jugular venous pressures to monitor pulmonary artery pressure during the Fontan procedure.
  
  
  BACKGROUND
  During the Fontan procedure, the internal jugular vein is used to assess pulmonary artery pressure. The risk of venous thrombosis in the low-pressure Fontan circuit may compromise the long-term success of cavopulmonary anastomosis. This study compared external and internal jugular venous pressures, femoral venous pressure, and actual pulmonary artery pressure during the Fontan procedure.
  
  
  METHODS
  32 children undergoing a single-stage Fontan on cardiopulmonary bypass were monitored for mean external and internal jugular venous pressures and femoral venous pressure pre- and post-cardiopulmonary bypass. Pulmonary artery pressure was also recorded directly after cardiopulmonary bypass. The pressure data were analyzed using analysis of variance, and the coefficient of correlation was found.
  
  
  RESULTS
  The differences between external jugular, internal jugular, and femoral venous pressure pre-cardiopulmonary bypass, and between the 3 venous pressures and the pulmonary artery pressure after cardiopulmonary bypass were found to be non-significant. The coefficient of correlation of external jugular venous pressure and internal jugular venous pressure was 0.8163 (p < 0.0001) pre-cardiopulmonary bypass, and 0.6465 (p = 0.0001) post-cardiopulmonary bypass.
  
  
  CONCLUSIONS
  The external jugular venous pressure correlates well with both internal jugular venous pressure and femoral venous pressure as a marker of pulmonary artery pressure in children undergoing the Fontan procedure. The use of external jugular venous pressure may also preclude the risk of thrombosis.
authors.affiliation: Department of Cardiac Anaesthesia, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Sumit
authors.initials: S
authors.lastname: Vasdev
authors.forename: Sandeep
authors.initials: S
authors.lastname: Chauhan
authors.forename: Sachin
authors.initials: S
authors.lastname: Talwar
authors.forename: Anil
authors.initials: A
authors.lastname: Pandey
authors.forename: Usha
authors.initials: U
authors.lastname: Kiran
mesh_terms: D000367:Age Factors; D062186:Arterial Pressure; D001795:Blood Pressure Determination; D002315:Cardiopulmonary Bypass; D002496:Central Venous Pressure; D002648:Child; D002675:Child, Preschool; D005268:Femoral Vein / Q000503:physiopathology; D018729:Fontan Procedure / Q000009:adverse effects; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007601:Jugular Veins / Q000503:physiopathology; D016343:Monitoring, Intraoperative / Q000379:methods*; D011237:Predictive Value of Tests; D011651:Pulmonary Artery / Q000503:physiopathology*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control
keywords: Cavopulmonary anastamosis; Fontan procedure; jugular veins; monitoring