Preliminary Experience Using Diastolic Right Ventricular Pressure Gradient Monitoring in Cardiac Surgery

Grønlykke, Lars; Couture, Étienne J.; Haddad, François; Amsallem, Myriam; Ravn, Hanne Berg; Raymond, Meggie; Beaubien‐Souligny, William; Demers, Philippe; Rochon, Antoine; Sarabi, Mahsa Elmi; Lamarche, Yoan; Desjardins, Georges; Denault, André

doi:10.1053/j.jvca.2019.12.042

Cited by 20 publications

(13 citation statements)

References 46 publications

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“…However, there are also reports describing a good correlation between both methods [86]. PAC complements information on RV function by providing pulmonary artery pressure monitoring and oxygen saturation [87,88]. This is particularly important in difficult and complex situations and procedures [89,90].…”

Section: Comparison To Other Techniques Of Rv Function Assessmentmentioning

confidence: 98%

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Role of Echocardiography for the Perioperative Assessment of the Right Ventricle

Labus

Uhlig

2021

Curr Anesthesiol Rep

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Purpose of Review This review aims to highlight the perioperative echocardiographic evaluation of right ventricular (RV) function with strengths and limitations of commonly used and evolving techniques. It explains the value of transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) and describes the perioperative changes of RV function echocardiographers should be aware of. Recent Findings RV dysfunction is an entity with strong influence on outcome. However, its definition and assessment in the perioperative interval are not well-defined. Moreover, values assessed by TTE and TEE are not interchangeable; while some parameters seem to correlate well, others do not. Myocardial strain analysis and three-dimensional echocardiography may overcome the limitations of conventional echocardiographic measures and provide further insight into perioperative cardiac mechanics. Summary Echocardiography has become an essential part of modern anesthesiology in patients with RV dysfunction. It offers the opportunity to evaluate not only global but also regional RV function and distinguish alterations of RV contraction.

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Section: Comparison To Other Techniques Of Rv Function Assessmentmentioning

confidence: 98%

“…Identifying RVDD seems to be of value in the perioperative setting. However, more data, either assessed by echocardiography, by PAC, or even both techniques, is needed to draw further conclusions [75,88].…”

Section: Future Directionsmentioning

confidence: 99%

Role of Echocardiography for the Perioperative Assessment of the Right Ventricle

Labus

Uhlig

2021

Curr Anesthesiol Rep

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“…The techniques employed by the aforementioned studies derived metrics of RV performance and right sided cardiac output indirectly, as opposed to the technique (particularly RVP waveform analysis) employed in this study, which has the benefit of measuring RV hemodynamic parameters directly. While direct transduction of the RV waveform using a PAC with an appropriately positioned RV lumen is increasingly employed in cardiac anesthesiology [8,24], it has not been described during OLT. Additionally, the effects of the various phases of the procedure on the RVOT gradient, dP/dt, or early-to-end-diastolic pressure difference have similarly not been described.…”

Section: Plos Onementioning

confidence: 99%

Preliminary experience with continuous right ventricular pressure and transesophageal echocardiography monitoring in orthotopic liver transplantation

Miles

Couture²,

Potes

et al. 2022

PLoS ONE

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Background Despite increasing attention in the cardiac anesthesiology literature, continuous measurement of right ventricular pressure using a pulmonary artery catheter has not been described in orthotopic liver transplantation, despite similarities in the anesthetic approach to the two populations. We describe our preliminary experience with this technique in orthotopic liver transplantation, and by combining various derived measures with trans-esophageal echocardiography, make some early observations regarding the response of these measures of right ventricular function during the procedure. Methods In this case series, ten patients (five men and five women) undergoing orthotopic liver transplantation in our institution had their surgeries performed while monitored with a pulmonary artery catheter with continuous right ventricular port transduction and trans-esophageal echocardiography. We recorded various right ventricular waveform (early-to-end diastolic pressure difference, right ventricular outflow tract gradient, right ventricular dP/dT and right ventricular end-diastolic pressure) and echocardiographic (right ventricular fractional area change, tricuspid annular plane systolic excursion, right ventricular lateral wall strain) and described their change relative to baseline at timepoints five minutes before and after portal vein reperfusion, immediately after hepatic artery reperfusion and on abdominal closure. Results Except for tricuspid annular plane systolic excursion at five minutes prior to reperfusion (mean −0.8 cm; 95% CI−1.4, –0.3; p = 0.007), no echocardiographic metric was statistically significantly different at any timepoint relative to baseline. In contrast, changes in right ventricular outflow tract gradient and right ventricular dP/dt were highly significant at multiple timepoints, generally peaking immediately before or after reperfusion before reducing, but not returning to baseline in the neohepatic phase. Nine of 10 participants in this series demonstrated a degree of dynamic right ventricular outflow tract obstruction, which met criteria for hemodynamic significance (> 25 mmHg) in two participants. These changes were not materially affected by cardiac index. Conclusions Dynamic right ventricular outflow tract obstruction of varying severity appears common in patients undergoing orthotopic liver transplantation. These results are hypothesis generating and will form the basis of future prospective research.

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“…2 a) [ 23 ]. Analysis of the RV waveform can be useful in early detection and subsequent management of RV dysfunction, especially during cardiac surgery [ 35 , 54 ]. Under conditions of impaired RV function, the diastolic slope may change.…”

Section: Placement Of the Pulmonary Artery Cathetermentioning

confidence: 99%

The contemporary pulmonary artery catheter. Part 1: placement and waveform analysis

Bootsma

Boerma

Lange

et al. 2021

J Clin Monit Comput

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Nowadays, the classical pulmonary artery catheter (PAC) has an almost 50-year-old history of its clinical use for hemodynamic monitoring. In recent years, the PAC evolved from a device that enabled intermittent cardiac output measurements in combination with static pressures to a monitoring tool that provides continuous data on cardiac output, oxygen supply and-demand balance, as well as right ventricular (RV) performance. In this review, which consists of two parts, we will introduce the difference between intermittent pulmonary artery thermodilution using cold bolus injections, and the contemporary PAC enabling continuous measurements by using a thermal filament which at random heats up the blood. In this first part, the insertion techniques, interpretation of waveforms of the PAC, the interaction of waveforms with the respiratory cycle and airway pressure as well as pitfalls in waveform analysis are discussed. The second part will cover the measurements of the contemporary PAC including measurement of continuous cardiac output, RV ejection fraction, end-diastolic volume index, and mixed venous oxygen saturation. Limitations of all of these measurements will be highlighted there as well. We conclude that thorough understanding of measurements obtained from the PAC are the first step in successful application of the PAC in daily clinical practice.

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Preliminary Experience Using Diastolic Right Ventricular Pressure Gradient Monitoring in Cardiac Surgery

Cited by 20 publications

References 46 publications

Role of Echocardiography for the Perioperative Assessment of the Right Ventricle

Role of Echocardiography for the Perioperative Assessment of the Right Ventricle

Preliminary experience with continuous right ventricular pressure and transesophageal echocardiography monitoring in orthotopic liver transplantation

The contemporary pulmonary artery catheter. Part 1: placement and waveform analysis

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