Key result
During abdominal aortic aneurysm repair, pulmonary artery occlusion pressure showed a relatively weak overall correlation with left ventricular end-diastolic area (r=0.37, P<0.0001).
Why the study?
Does pulmonary artery occlusion pressure accurately reflect left ventricular end-diastolic volume as measured by TEE in patients undergoing abdominal aortic aneurysm repair?
Observational (n=22)
Does pulmonary artery occlusion pressure accurately reflect left ventricular end-diastolic volume as measured by TEE in patients undergoing abdominal aortic aneurysm repair?
PAOP correlates weakly with LVEDA during AAA repair, particularly after aortic unclamping, suggesting TEE is a valuable adjunct for guiding volume resuscitation.
BACKGROUND: Clinical observations suggest that pulmonary artery occlusion pressure (PAOP) underestimates the resuscitative volumes required prior to release of aortic cross-clamp.METHODS: To investigate pressure-volume relationships associated with repair of abdominal aortic aneurysm (AAA), we simultaneously monitored PAOP by pulmonary artery catheter (PAC) and estimated left ventricular (LV) diastolic volume using two-dimensional transesophageal echocardiography (TEE) in 22 patients undergoing AAA repair.Data from PAC monitoring and TEE were collected before, during, and after aortic occlusion.TEE cross-sectional images were obtained at the mid-papillary level.RESULTS: Overall, PAOP correlated with left ventricular end-diastolic area (LVEDA), but the correlation was not particularly strong (r ffi 0.37, P <0.0001).Even within individual patients, LVEDA varied widely for a given PAOP.The strength of the correlation between PAOP and LVEDA also appeared to deteriorate during the course of surgery.The best correlation was seen prior to aortic cross-clamping (r ffi 0.50, P <0.0001), but fell somewhat during aortic cross-clamping (r = 0.41, P <0.0001), and even further after unclamping (r ffi 0.25, P ffi 0.005). CONCLUSION:This study demonstrates a relatively weak correlation between PAOP and LVEDA using intraoperative TEE during AAA repair.Furthermore, the strength of the correlation worsened during surgery, particularly after unclamping.Although unclear at this lime, this findhag may be attributable to changes in LV compliance.We found TEE to be a valuable adjunct in guiding volume resuscitation of patients undergoing AAA repair.T he use of pulmonary artery catheters has become com- monplace in the management of the critically ill patient for the evaluation of left ventricular preload.The pulmonary artery occlusion pressure (PAOP) as measured by the Swan-Ganz catheter is utilized clinically to provide a measure of the left ventricular end diastolic pressure From the Section of Vascular Surgery (DLG, JOM)
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Gillespie et al. (1994) conducted an observational in Abdominal aortic aneurysm (n=22). Simultaneous monitoring of PAOP by pulmonary artery catheter and LVEDA by TEE was evaluated on Correlation between pulmonary artery occlusion pressure (PAOP) and left ventricular end-diastolic area (LVEDA) (r = 0.37, p=<0.0001). During abdominal aortic aneurysm repair, pulmonary artery occlusion pressure showed a relatively weak overall correlation with left ventricular end-diastolic area (r=0.37, P<0.0001).
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