Methodology of True Pulmonary Blood Volume Determination

Abstract

THE pulmonary blood volume may be defined as the volume of blood interposed between the pulmonary artery, at the pulmonary valve, and the left atrium. The volume has been measured either on a relative or on an absolute basis, that is, by measurement of changes in pulmonary blood volume or by determination of the actual volume. The former method includes determination of lung volumes, or of pulmonary compliance, use of radioactive tracers to detect changes in radioactivity over specific areas of the lung, and use of a critically balanced teeter board.' Absolute values for pulmonary blood volume have generally been obtained by the indicatordilution technique in which the indicator is introduced into the right side of the heart and sampled from the systemic arterial tree.2 4 The volume measured varied with the injection site, that is, the peripheral venous tree, the right heart, or the pulmonary artery. The results have been analyzed by the StewartHamilton,2 3 the Bradley equilibration,5 and the Newman exponential downslope6 methods. Only the first of these approaches2 3 has proven to be applicable to the determination of pulmonary blood volume.' However, the blood volume so defined still varies with the exact injection and sampling sites employed. More recently Giuntini and associates7 described a precordial radioactive method for determining true pulmonary blood volume.The development of transseptal left heart catheterization has permitted more exact From tiie Section definition of the pulmonary blood volume by the indicator-dilution method. Three approaches have been utilized: In the first, indicator is injected into both the pulmonary artery and the left atrium and sampled from a systemic artery.8 9 The difference between the pulmonary-systemic artery volume and the left atrial-systemic artery volume is defined as the "true" pulmonary blood volume. In the second method the indicator is injected into the pulmonary artery and sampled from the left atrium.10 In the third method, indicator is injected into the superior vena cava or right atrium and sampled from the pulmonary artery and left atrium." The difference between the right atrial-left atrial volume and the right atrial-pulmonary artery volume is again defined as the "true" pulmonary blood volume. The purpose of this report is to compare the results of all three of these techniques for determination of pulmonary blood volume in 96 subjects. MethodsThe patients ranged from 17 to 64 years in age; they were studied in the fasting state. Rheumatic heart disease with mitral or aortic valve disease or both was the most common diagnosis. Congenital heart disease without a right-to-left or left-to-right shunt was present in some patients; a few were found to be free of heart disease after complete study. Indocyanine-green in doses of 2 to 3.5 mg together with saline flushes were utilized to inscribe the indicator-dilution curves from the various sites. A no. 5, 80-cm long Lehman catheter was passed into the superior vena cava or right atrium. A no. 6, 100-cm Lehman ...

Determinants of pulmonary blood volume

“…is not statistically significant. Although individual discrepancies of greater than 25% were observed in four of the 25 comparisons, this proportion is not greater than that reported by Samet, Bernstein, Lopez, and Levine who compared two dye injection methods of measuring PMTT (27).…”

Pulmonary vascular volume, impaired left ventricular filling and dyspnea: The MESA Lung Study

“…Percent TPVV is TPVV indexed to CT lung volume. The TPVV (mean of 130.7 cm 3 or 70.7 cm 3 /m 2 in this study) captures approximately 25–30% of the pulmonary blood volume estimated using invasive methods (250–300 cm 3 /m 2 ) [15, 16]. This difference is not unexpected, given that the TPVV does not capture the microvasculature (capillary blood volume, estimated as ~140 mL) [17], pre-capillary arterioles and venules, and that the main, right and left pulmonary arteries and veins were excluded from the TPVV but included in invasive measures.…”

Pulmonary mean-transit-time blood volumes in anesthetized dogs.

“…Reports differ with regard to the relationship between pulmonary blood volume and stroke volume, flow rate, and mean systemic arterial pressure (5)(6)(7)(14)(15)(16)19,22,23,29). Although some authors (29,31) have observed no correlation between pulmonary blood volume and right atrial and pulmonary artery pressures in intact animals, in isolated perfused lungs Permutt and associates (17) found a close relationship between pulmonary blood volume and pulmonary artery pressure while left atrial pressure had little or no influence.…”