Der Herzkathetertisch ist nicht der OP-Tisch

Abstract

An elevated pulmonary pressure obtained preoperatively during right heart catheterization is not indicative of an elevated pulmonary pressure either intraoperatively or postoperatively. There are various explanations for the differences (e.g., different physiological and pathophysiological settings, such as sedation with potential hypercapnia versus anesthesia with vasodilation when measured; newly prescribed medication coming into effect between the right heart catheterization and surgery; intraoperative positioning). Even though the inherent risks of a PAC seem to be low, we recommend refraining from using a PAC in patients with a once documented elevated pulmonary pressure by default. As an alternative we suggest estimating the pulmonary pressure by transesophageal echocardiography (TEE) as an aid to decide whether the patient will benefit from the use of a PAC. Especially if it is not possible to identify tricuspid valve regurgitation for determining the peak gradient, it is helpful to check for additional signs of pulmonary hypertension. But we also have to bear in mind that in the postoperative period only a PAC can provide continuous measurement of pulmonary pressure.

A better method to evaluate the reliability of echocardiography for assessment of pulmonary hypertension: comparison of tricuspid regurgitant spectrum quality grading and tricuspid valve regurgitation degree

“…Bias informs about accuracy, and agreement informs about precision. Previous studies demonstrated that the inherent instability and/or interventions (e.g., diuretics) that occur between studies could have influenced the findings ( 35 , 36 ). Our hypothesis was that medication taken before to RHC may reduce the risk of RHC in patients with severe PH (US-PASP >70 mmHg), and may be the main reason for the bias and agreement gap between TR-SQG III and IV.…”

“…This can be explained by the shorter measurement time intervals between TTE and RHC after BPA. Although patients with PH may experience with spontaneous fluctuations in up to 22% for PAMP and 36% for PVR within only a few hours ( 36 ). Ni et al ( 15 ) demonstrated that shortening the time interval between TTE and RHC could improve the accuracy of TTE and the diagnostic accuracy was the highest when the time period was less than or equal to 24 hours.…”