Catheterization Of Left Atrium Research Articles

The perioperative application of using norepinephrine through the catheterization of left atrium in patients of congenital heart disease with sever pulmonary arteries hypertension

Objective To evaluate the curative effects of using norepinephrine through the catheterization of left atrium in patients of congenital heart disease with sever pulmonary arteries hypertension (SPAH) during perioperative period.Methods Forty pediatric patients of both sexes scheduled for elective congenital heart disease complicated with moderate-to-severe pulmonary hypertension under cardiopulmonary bypass,were randomly diveded into 2 groups(n =20 each):control group (C group) and transfusing the norepinephrine through the catheterization of left atrium group (L group).After the cardiac resuscitation,C and L groups were continuous given infusion of dopamine,dobutamine,epinephrine,nitroglycerin and at the same time the L group were transfused the norepinephrine through the catheterization of left atrium.The hemodynamic parameters,blood lactate values of each group at parallel loop (T1),15 min after CPB shutdown (T2),end of the surgery (T3),24 h after the surgery (T4) were recorded.The main and pulmonary artery pressure inversion rate of the patients,the incidence of right heart failure,duration of mechanical ventilation and duration of stay in intensive care unit,the the incidence of postoperative pulmonary complications,mortality were also recorded.Results In group C and L,the main and pulmonary artery pressure inversion rate of the patients were 55％ and 5％,the incidence of right heart failure were 80％ and 5％,the duration of mechanical ventilation were (123.00 ± 13.50) h and (76.00 ±7.25) h,the duration of stay in intensive care unit were (8.00 ± 1.60) d and (5.00 ± 0.70) d,the incidence of postoperative pulmonary complications were 70％ and 10％,and the mortality were 10％ and 0％.Compared with C group,the results of group L were much belower (P ＜ 0.05).Conclusion The therapeutic idea that using norepinephrine through the catheterization of left atrium to maintain adequate cardiac output and peripheral vascular resistance is superior for postoperative complications and mortality reduction in patients of congenital heart disease with SPAH after operation. Key words: Catheterization; Left atrium ; Norepinephrine ; Congenital heart disease; Pulmonary arteries hypertension

Efficacy of catheterization of left atrium for postoperative management in pediatric patients undergoing congenital heart disease complicated with moderate to severe pulmonary hypertension

Objective To evaluate the efficacy of catheterization of left atrium for postoperative management in pediatric patients undergoing congenital heart disease complicated with moderate to severe pulmonary hypertension.Methods Sixty ASA Ⅲ or Ⅳ pediatric patients of both sexes,aged 9 months-14 yr,scheduled for elective congenital heart disease complicated with moderate-to-severe pulmonary hypertension under cardiopulmonary bypass,were randomly divided into 2 groups (n =30 each):central venous catheterzation group (C group)and catheterization of left atrium group (L group).After induction of anesthesia,triple-lumen central venous catheters were inserted in both groups.In group L,the right internal jugular vein was cannulated with a single lumen venous catheter passed through the left atrium for monitoring postoperative left atrial pressure (LAP) and administration of vasoactive drug and LAP was maintained at 8-12 mm Hg after operation.Duration of mechanical ventilation and duration of stay in intensive care unit were recorded.The amount of dopamine,dobutamine,nitroprusside,milrinone,and alprostadil consumed within 48 h after operation was also recorded.Results Compared with C group,the amount of dopamine,dobutamine,nitroprusside,milrinone,and alprostadil consumed was significantly reduced and duration of mechanical ventilation and duration of stay in intensive care unit were significantly shortened in group L.Conclusion Catheterization of left atrium is used for monitoring postoperative LAP,which can provide a basis for reasonable clinical prescription and optimize the efficacy of postoperative management in pediatric patients undergoing congenital heart disease complicated with moderate to severe pulmonary hypertension. Key words: Catheterization; Heart atria function, left ; Heart defects, congenital; Hypertension,pulmonary