Measurement of Pulmonary Edema in Valvular Heart Disease

McCredie, Michael

doi:10.1161/01.cir.36.3.381

Cited by 53 publications

(9 citation statements)

References 13 publications

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“…The latter is probably a consequence of an elevated left ventricular diastolic pressure, which may be a manifestation of either left ventricular failure or a decrease in left ventricular compliance. XLIX, January 1974 found almost uniformly in patients with pulmonary edema.2' 4,5,8 Sutherland, Cade and Pain have reported increased PEV in six of fourteen patients with acute myocardial infarction. '0 These six patients had clinical evidence of more severe left ventricular failure and greater veno-arterial shunting and hypoxemia than those in whom PEV was not elevated.…”

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confidence: 98%

Lung Water in Patients with Acute Myocardial Infarction

Biddle

Khanna

et al. 1974

Circulation

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SUMMARYPulmonary extravascular water volume (PEV) or lung water was measured in 45 patients with acute myocardial infarction, utilizing the double radioisotope indicator dilution technique. A PEV greater than the upper limit or normal (120 m/m2) was found in 27 patients, 23 of whom had an elevated pulmonary wedge or pulmonary artery diastolic pressure. A significant correlation was found between PEV and pulmonary wedge or pulmonary diastolic pressure in the whole series. A progressive increase in average PEV was observed from Class I (uncomplicated) to Class IV (shock) patients. There was also a progressive increase in PEV from patients with normal chest X-ray findings to those with radiologic evidence of acute pulmonary edema. In seven of 11 patients with initial elevation of both PEV and pulmonary wedge pressure, repeat determinations demonstrated a substantial reduction in both parameters over a period of 2-4 days.We postulate that an increased PEV in patients with acute myocardial infarction is largely due to an elevated pulmonary capillary pressure. The latter is probably a consequence of an elevated left ventricular diastolic pressure, which may be a manifestation of either left ventricular failure or a decrease in left ventricular compliance. XLIX, January 1974 found almost uniformly in patients with pulmonary edema.2' 4,5,8 Sutherland, Cade and Pain have reported increased PEV in six of fourteen patients with acute myocardial infarction.'0 These six patients had clinical evidence of more severe left ventricular failure and greater veno-arterial shunting and hypoxemia than those in whom PEV was not elevated.The present study was undertaken to assess the relationship of PEV with (a) clinical classification, (b) roentgenographic findings, and (c) pulmonary artery and pulmonary wedge pressures in 45 patients with documented acute myocardial infarction.

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confidence: 98%

Lung Water in Patients with Acute Myocardial Infarction

Biddle

Khanna

et al. 1974

Circulation

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“…This exclusion of patients with large shunt values on air before operation was performed to exclude those with probable subclinical pulmonary oedema (McCredie, 1967). The results both with and without these exclusions are shown.…”

Section: Resultsmentioning

confidence: 99%

Methyl prednisolone and lung function after cardiopulmonary bypass.

Enderby¹,

Boylett²,

Parker³

1979

Thorax

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Thirty-one patients who were undergoing cardiopulmonary bypass for elective aortic valve replacement were studied. The effects on some aspects of lung function of intravenous methyl prednisolone, administered immediately before bypass, were assessed by measuring alveolar-arterial oxygen differences and shunt fractions. No significant differences in pulmonary function were found between the treated and control groups. The use of methyl prednisolone in this context is not justified.Although the frequency and severity of pulmonary dysfunction after open intracardiac surgery using cardiopulmonary bypass has decreased, it may cause significant morbidity and is occasionally the primary factor in mortality. The aetiology of pulmonary dysfunction has been disputed since the early days of open heart surgery, and no consensus exists at present. Denaturation of plasma proteins (Lee et al, 1961;Pruitt et al, 1971) at the gas air interface in the oxygenator has been the most widely supported cause. It is postulated that damage to the pulmonary capillary membrane is an essential feature of the classic pathological findings, which in all degrees are associated with an increase in interstitial alveolar fluid (Baerand Osborn, 1960). Wilson (1972) proposed that polymorphonuclear leucocytes and platelets may be incriminated in the presumed membrane damage and suggested that methyl prednisolone hemisuccinate could reduce it. He reported a significant reduction in membrane damage in patients undergoing cardiopulmonary bypass who received methyl prednisolone, as assessed by lung biopsy at the end of operation. However, there was no physiological evidence to support the histological evidence. Extravascular lung water, measured by a double indicator dilution technique, increases after cardiac surgery using extracorporeal circulation. There was no change in the colloid and hydrostatic forces that act on the capillary membrane (Parker et al, 1972). These changes are associated with a deterioration in the gas exchange of the lungs, which is maximal about 48 hours after operation and has not returned to normal after seven days.To determine whether methyl prednisolone hemisuccinate can produce changes in gas exchange to parallel the changes in histology, a double-blind trial of the effect of the drug given immediately before the onset of bypass has been undertaken. MethodsThirty-one patients who were undergoing elective operations for aortic valve disease were studied. A standard random selection technique was used, excluding any patients with obvious lung disease or frank left ventricular failure. Informed consent for the investigations was obtained and if at any time the subject found the tests intolerable the study on that patient was terminated, and the results excluded. These exclusions account for the odd numbered total. Investigations were performed at the following time intervals: (1) before operation, (2) 48 hours after operation, and (3) one week after operation.The investigation consisted of arterial blood sampling while...

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“…2,16 Increased PEW has been demonstrated in patients (1) with functional capacity of classes II, III, and IV (NYHA), (2) with congestive heart failure, and (3) …”

Section: Discussionmentioning

confidence: 99%

Pulmonary Intravascular and Extravascular Fluid Volumes in Exercising Cardiac Patients

et al. 1971

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SUMMARYPulmonary extravascular (PEW) and intravascular (PBV) fluid volumes were measured during cardiac catheterization by a multiple indicator-dilution technique in 21 cardiac patients at rest and during exercise.Increased PEW at rest was clearly related to increased left atrial and pulmonary artery pressures but not to blood flow or pulmonary vascular resistance.Submaximal supine exercise produced increased intracardiac pressures and flow, with PEW and PBV significantly increased in most cases' and stable in a few. Transudation at higher pulmonary capillary pressures and increased capillary recruitment were proposed to explain the increases in PEW during this short-term stress.Two patients developed overt pulmonary edema with rales during exercise. These individuals are discussed separately. The present study will explore the effect on pulmonary intravascular and extravascular fluid volumes of changing pressure, flow, and metabolic alterations associated with exercise in patients with various forms of heart disease. Methods Patient MaterialIn 21 patients, pulmonary intravascular (PBV), and extravascular (PEW) volume determinations' were included as part of regular diagnostic catheterizations. Ages of the patients varied from 22 to 66 years. Of the total group, three were considered hemodynamic normals, having central pressure and flow measurements

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Measurement of Pulmonary Edema in Valvular Heart Disease

Cited by 53 publications

References 13 publications

Lung Water in Patients with Acute Myocardial Infarction

Lung Water in Patients with Acute Myocardial Infarction

Methyl prednisolone and lung function after cardiopulmonary bypass.

Pulmonary Intravascular and Extravascular Fluid Volumes in Exercising Cardiac Patients

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