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Ann Thorac Surg 1987;44:31-34
© 1987 The Society of Thoracic Surgeons

Articles

Unreliability of Hemodynamic Indexes of Left Ventricular Size during Cardiac Surgery

Pamela S. Douglas, M.D., L. Henry Edmunds, M.D., Martin St. John Sutton, M.B. M.R.C.P., Ralph Geer, M.D., Alden H. Harken, M.D., Nathaniel Reichek, M.D.

From the Cardiovascular Section and the Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA

Accepted for publication November 19, 1986.

Pulmonary artery diastolic (PADP) and wedge pressures (PAWP) and left ventricular end-diastolic pressure (LVEDP) are commonly used to estimate left ventricular (LV) preload. To assess the ability of hemodynamic indexes of preload to estimate anatomical preload, or LV volume, we studied 45 patients during a coronary (18 patients) or aortic valve (27 patients) procedure and compared epicardial two-dimensional echocardiographic LV cavity area with simultaneous measurements of PADP, PAWP, and high-fidelity LVEDP.

Pulmonary artery diastolic pressure, PAWP, and their percent change after bypass did not correlate with absolute values (before or after bypass) or percent change in LVEDP. Percent change in LV area correlated weakly with percent change in PADP (r = .34, p < .03) but not with changes in PAWP or LVEDP. Changes were opposite in direction in 45% (PADP), 50% (PAWP), and 67% (LVEDP) of patients.

In conclusion, both PADP and PAWP were poor guides to LVEDP and neither reflected changes in LV size. Thus, hemodynamic indexes of preload should be used with caution during cardiac operations.




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