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Ann Thorac Surg 1996;62:319
© 1996 The Society of Thoracic Surgeons

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Correspondence

Central Venous Pressure/Pulmonary Capillary Wedge Pressure Ratio

Department of Anesthesiology Siyami Ersek Thoracic and Cardiovascular Center Istanbul, Turkey

To the Editor:

I read with great interest the article by Dávila-Román and associates [1] entitled "Right Ventricular Dysfunction in Low Output Syndrome After Cardiac Operations: Assessment By Transesophageal Echocardiography." I believe that their observations are valuable. They state that they use the ratio of right atrial (central venous pressure [CVP]) to pulmonary capillary wedge pressure (PCWP) to detect right or biventricular dysfunction after cardiac operations. The importance of CVP/PCWP ratio to detect right ventricular dysfunction during the termination of cardiopulmonary bypass has been described by Kopman and Ferguson [2].

I appreciate the interest that Dávila-Román and associates have shown in our definition of CVP/PCWP ratio, and welcome the opportunity to write this letter to the editor. (1) I believe that Dávila-Román and associates should give the appropriate reference and cite our names. (2) It has been my personal experience that CVP/PCWP ratio has been a useful hemodynamic criteria during the attempt to terminate cardiopulmonary bypass. Overloading of the right ventricle is a more common occurrence than isolated right heart failure at the termination of cardiopulmonary bypass. If the right ventricle is overloaded relative to the left ventricle, termination of cardiopulmonary bypass may become difficult or even impossible. The best treatment of this condition is to go back on cardiopulmonary bypass and to restore normal CVP/PCWP ratio by emptying the right ventricle. This simple measure usually helps to restore hemodynamic balance between the ventricles.

References

1. Dávila Román VG, Waggoner AD, Hopkins WE, Barzilai B. Right ventricular dysfunction in low output syndrome after cardiac operations: assessment by transesophageal echocardiography. Ann Thorac Surg 1995;60:1081–6.[Abstract/Free Full Text]
2. Kopman EA, Ferguson TB. Interaction of right and left ventricular filling pressures at the termination of cardiopulmonary bypass. Central venous pressure/pulmonary capillary wedge pressure. J Thorac Cardiovasc Surg 1985;89:706–8.[Abstract]

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