Transesophageal Echocardiographic Measurement of Cardiac Index by the Prosthetic Mitral Valve Method Is Not Similar to the Continuous Thermodilution Method Via a Pulmonary Artery Catheter

2016 ◽  
Vol 30 (2) ◽  
pp. 398-405 ◽  
Author(s):  
Hongwei Shi ◽  
Zhenhong Wang ◽  
Haiyan Wei ◽  
Yali Ge ◽  
Xin Chen
Keyword(s):  
Mitral Valve ◽  
Cardiac Index ◽  
Pulmonary Artery ◽  
Pulmonary Artery Catheter ◽  
Thermodilution Method ◽  
Echocardiographic Measurement ◽  
Prosthetic Mitral Valve

scholarly journals Cephalad misplacement of a pulmonary artery catheter in a patient with a preexisting Hickman catheter

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hoon Choi ◽  
Joon Pyo Jeon ◽  
Jaewon Huh ◽  
Youme Kim ◽  
Wonjung Hwang
Keyword(s):  
Mitral Valve ◽  
Pulmonary Artery ◽  
Pulmonary Artery Catheter ◽  
Case Reports ◽  
Mitral Valve Regurgitation ◽  
Catheter Insertion ◽  
Routine Practice ◽  
Hickman Catheter ◽  
Risk Patients ◽  
The Right

Abstract Background Pulmonary artery catheter insertion is a routine practice in high-risk patients undergoing cardiac surgery. However, pulmonary artery catheter insertion is associated with numerous complications that can be devastating to the patient. Incorrect placement is an overlooked complication with few case reports to date. Case presentation An 18-year-old male patient underwent elective mitral valve replacement due to severe mitral valve regurgitation. The patient had a history of synovial sarcoma, and Hickman catheter had been inserted in the right internal jugular vein for systemic chemotherapy. We made multiple attempts to position the pulmonary artery catheter in the correct position but failed. A chest radiography revealed that the pulmonary artery catheter was bent and pointed in the cephalad direction. Removal of the pulmonary artery catheter was successful, and the patient was discharged 10 days after the surgery without complications. Conclusions To prevent misplacement of the PAC, clinicians should be aware of multiple risk factors in difficult PAC placement, and be prepared to utilize adjunctive methods, such as TEE and fluoroscopy.

Current Use and Impact on 30-Day Mortality of Pulmonary Artery Catheter in Cardiogenic Shock Patients: Results From the CardShock Study

2019 ◽  
Vol 35 (12) ◽  
pp. 1426-1433 ◽  
Author(s):  
Alessandro Sionis ◽  
Mercedes Rivas-Lasarte ◽  
Alexandre Mebazaa ◽  
Tuukka Tarvasmäki ◽  
Jordi Sans-Roselló ◽  
...  
Keyword(s):  
Cardiac Index ◽  
Pulmonary Artery ◽  
Cardiogenic Shock ◽  
Pulmonary Artery Catheter ◽  
Risk Score ◽  
Stroke Volume Index ◽  
Volume Index ◽  
Propensity Score Matching Analysis ◽  
Net Reclassification Improvement ◽  
Life Threatening

Background: Cardiogenic shock (CS) is the most life-threatening manifestation of acute heart failure. Its complexity and high in-hospital mortality may justify the need for invasive monitoring with a pulmonary artery catheter (PAC). Methods: Patients with CS included in the CardShock Study, an observational, prospective, multicenter, European registry, were analyzed, aiming to describe the real-world use of PAC, evaluate its impact on 30-day mortality, and the ability of different hemodynamic parameters to predict outcomes. Results: Pulmonary artery catheter was used in 82 (37.4%) of the 219 patients. Cardiogenic shock patients who managed with a PAC received more frequently treatment with inotropes and vasopressors, mechanical ventilation, renal replacement therapy, and mechanical assist devices ( P < .01). Overall 30-day mortality was 36.5%. Pulmonary artery catheter use did not affect mortality even after propensity score matching analysis (hazard ratio = 1.17 [0.59-2.32], P = .66). Cardiac index, cardiac power index (CPI), and stroke volume index (SVI) showed the highest areas under the curve for 30-day mortality (ranging from 0.752-0.803) and allowed for a significant net reclassification improvement of 0.467 (0.083-1.180), 0.700 (0.185-1.282), 0.683 (0.168-1.141), respectively, when added to the CardShock risk score. Conclusions: In our contemporary cohort of CS, over one-third of patients were managed with a PAC. Pulmonary artery catheter use was associated with a more aggressive treatment strategy. Nevertheless, PAC use was not associated with 30-day mortality. Cardiac index, CPI, and SVI were the strongest 30-day mortality predictors on top of the previously validated CardShock risk score.

Abstract 19798: Should Downsizing Still Be the Gold Standard for Treatment of Ischemic Mitral Regurgitation?

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Boris Robic ◽  
Alexander Van De Bruaene ◽  
Thijs Cools ◽  
Jan Verwerft ◽  
Alaaddin Yilmaz ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Cardiac Index ◽  
Ejection Fraction ◽  
Pulmonary Artery ◽  
Stroke Volume ◽  
Pulmonary Artery Pressure ◽  
Gold Standard ◽  
Peak Exercise ◽  
Artery Pressure ◽  
Exercise Hemodynamics

Background: Mitral valve annuloplasty (MVA) or replacement (MVR) are common strategies in the treatment of functional ischemic mitral regurgitation (FIMR). However, the issue of functional stenosis during exercise in MVA patients was raised. This study aims to compare exercise hemodynamics of MVA and MVR patients. Methods: Thirty patients (23 MVA, 66.8±8.8 y at repair, and 7 MVR, 66.1±5.5y) underwent exercise echocardiography. Stroke volume, ejection fraction, cardiac index, mitral valve gradient, mitral valve area and pulmonary artery pressures were evaluated at rest and at peak exercise. Results: Both patient groups had comparable exercise capacity (65±16 vs 67±15 %predicted; P=0.760). In MVA patients, stroke volume (38±14 to 39±14 mL; P=0.707) and ejection fraction (51±15 to 55±14%; P=0.123) did not change, whereas cardiac index (2.9±1.1 to 4.2±1.2 L/min.m 2 ; P<0.0001), mitral valve gradient (peak 11.8±4.6 to 21.3±7.6 mmHg; mean 5.2±2.2 to 11.3±4.9 mmHg; both P<0.0001) and pulmonary artery pressure (33±10 to 51±16 mmHg; P<0.0001) increased during exercise. In MVR patients, stroke volume (29±7 to 35±7 ml; P=0.006), ejection fraction (52±12 to 61±14%; P=0.009), cardiac index (2.0±0.4 to 3.1±0.9 L/min.m 2 ; P=0.006), mitral valve gradient (peak 9.8±3.8 to 22.0±7.5 mmHg; mean 4.8±1.8 to 12.3±4.3 mmHg; both P<0.05) and pulmonary artery pressure (32±5 to 45±9 mmHg; P=0.006) all increased during exercise. Cardiac index at rest (P=0.040) and at peak exercise (P=0.038) was slightly higher in the MVA group, whereas pulmonary artery pressures at rest (P=0.750) and at peak exercise (P=0.293) were not statistically different. Total pulmonary resistance did not change during exercise (P=0.115 and P=0.546 for MVA and PVR respectively). In MVA, there was a relation between peak mitral valve gradient at rest and pulmonary artery pressure at rest (R=0.525, P=0.017) and at peak exercise (R=0.508; P=0.022). Conclusions: Surgical repair achieves leaflet coaptation at the expense of raised transmitral gradients. Even after successful MVA, patients had worse exercise hemodynamics and lack of mitral valve opening reserve. Therefore we should question downsizing as the gold standard for treatment of FIMR and look for a more patient tailored approach.

scholarly journals Correlation between Regional Cerebral Saturation and Invasive Cardiac Index Monitoring after Heart Transplantation Surgery

2018 ◽  
Vol 07 (04) ◽  
pp. 196-200
Author(s):  
Christoph Hornik ◽  
Ira Cheifetz ◽  
Andrew Lodge ◽  
George Ofori-Amanfo ◽  
Awni Al-Subu
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Cardiac Index ◽  
Pulmonary Artery ◽  
Heart Transplantation ◽  
Pulmonary Artery Catheter ◽  
Correlation Coefficient ◽  
Tertiary Care ◽  
Cardiac Intensive Care Unit ◽  
Cardiac Intensive Care

AbstractThe present study assessed the correlations between cerebral regional saturation detected by near infrared spectroscopy (NIRS) and cardiac index (CI) measured by pulmonary artery catheter. This was a retrospective cohort study conducted in the cardiac intensive care unit in a tertiary care children's hospital. Patients younger than 18 years of age who underwent heart transplantation and had a pulmonary artery catheter on admission to the pediatric cardiac intensive care unit between January, 2010, and August, 2013, were included. There were no interventions. A total of 10 patients were included with median age of 14 years (range, 7–17). Indications for transplantation were dilated cardiomyopathy (n = 9) and restrictive cardiomyopathy (n = 1). Mixed venous oxygen saturation (SvO2), cerebral regional tissue saturation (rSO2), and CI were recorded hourly for 8 to 92 hours post-transplantation. Spearman's rank correlation coefficient was used to assess correlations between SvO2 and cerebral rSO2 and between CI and cerebral rSO2. A total of 410 data points were collected. Median, 25th and 75th percentiles of cerebral rSO2, CI, and SvO2 were 65% (54–69), 2.9 L/min/m2 (2.2–4.0), and 75% (69–79), respectively. The correlation coefficient between cerebral rSO2 and CI was 0.104 (p = 0.034) and that for cerebral rSO2 and SvO2 was 0.11 (p = 0.029). The correlations between cerebral rSO2 and CI and between cerebral rSO2 and SvO2 were weak. Cerebral rSO2 as detected by NIRS may not be an accurate indicator of CI in critically ill patients.

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