Pulmonary Venous Wedge Pressure Research Articles

Evaluation of bilateral pulmonary artery banding for initial palliation in single-ventricle neonates and infants: risk factors for mortality before the bidirectional Glenn procedure.

Bilateral pulmonary artery banding is considered as 'first-stage' palliation for neonates who have hypoplastic left heart syndrome. This study aimed to identify risk factors that influence outcome before the bidirectional Glenn operation. This retrospective evaluation involved 30 consecutive patients with hypoplastic left heart syndrome, or a variant, who underwent bilateral pulmonary artery banding between August 2005 and December 2011 at our institution. Clinical echocardiographic, operative and catheter examination data were reviewed. This study included 9 patients with hypoplastic left heart syndrome and 21 patients with variants. Bilateral pulmonary artery banding was performed at a median age of 7 days. Finally, 19 patients had the bidirectional Glenn operation performed (Group A), and the remaining 11 patients died before the bidirectional Glenn procedure (Group NA). Catheter evaluations before the bidirectional Glenn procedure were carried out at 97 ± 34 days. The mean pulmonary venous wedge pressure was significantly lower (Group A: 13.1 ± 3.1 mmHg vs Group NA: 22.9 ± 3.7 mmHg, P <0.01), systemic ventricular ejection fraction was higher (54.4 ± 10.7 vs 41.7 ± 9.9%, P <0.05), systemic ventricular end-diastolic pressure was lower (6.1 ± 2.4 vs 10.5 ± 3.6 mmHg, P <0.05) and the rate of patients with more than mild systemic atrioventricular valve regurgitation was lower in Group A than in Group NA (15.7 vs 62.5%, P <0.05). Multivariate logistic regression analysis showed that mean pulmonary venous wedge pressure was the most significant predictor of attaining the bidirectional Glenn anastomosis (odds ratio: 2.35, P <0.01). Postoperative atrioventricular valve regurgitation, cardiac function and mean pulmonary venous wedge pressure are closely correlated with mortality after bilateral pulmonary artery banding. Additional treatments, including operations, are considered to maintain cardiac function and not to raise pulmonary venous wedge pressure before the bidirectional Glenn procedure.

Pulmonary venous wedge pressure provides a safe and accurate estimate of pulmonary arterial pressure in children with shunt-dependent pulmonary blood flow

To compare two methods of pulmonary arterial pressure measurement in children with shunt-dependent pulmonary blood flow. In children with shunt-dependent pulmonary blood flow, direct assessment of pulmonary arterial pressure requires passage of a catheter across the shunt. This can be technically difficult and dangerous. Use of the pulmonary venous wedge pressure offers an alternative but has not been validated in this patient population. We prospectively studied 18 children with shunt-dependent pulmonary blood flow. Pulmonary venous wedge pressure and directly measured pulmonary arterial pressures were independently assessed by two blinded cardiologists. Directly measured mean pulmonary arterial pressure and pulmonary venous wedge pressure are closely correlated (R2 = 0.80, P < 0.01). Agreement between the two measures is improved at lower mean pressures with greater differences at higher pressures. For 20 of 24 ipsilateral measurements, pulmonary venous wedge pressure was > or = directly measured pulmonary arterial pressure. Pulmonary venous wedge pressure never underestimated pulmonary arterial pressure by more than 3 mm Hg. Pulmonary venous wedge pressure provides a safe and accurate means of estimating pulmonary arterial pressure in children with shunt-dependent pulmonary blood flow. The slightly lower pressures seen on direct measurement compared with the reverse pulmonary vein may reflect impairment of flow across the shunt by the catheter.

Pulmonary venous wedge pressure provides an accurate assessment of pulmonary artery pressure in children with a bidirectional Glenn shunt.

In circulations with pulsatile pulmonary artery flow the pulmonary venous wedge pressure (PVWp) has been validated as a good estimate of pulmonary artery pressure (PAp), when PAp is low. The purpose of this study was to validate PVWp estimates of PAp in the less-pulsatile pulmonary circulation of children after bidirectional Glenn shunts. A retrospective study was performed of 22 simultaneous measurements of PVWp and PAp made during 20 catheterizations in 19 children who had undergone bidirectional Glenn procedures. The PAp was measured directly from the branch PA ipsilateral to the side of the PVWp, or in the SVC. Pulmonary resistance (Rp) was calculated with both PAp and PVWp, to assess the impact of PAp estimates on Rp determinations. Patients ranged in age from 5 months to 10.7 years. There were a variety of univentricular cardiac malformations in the study group. Two children had antegrade pulmonary blood flow in addition to a bidirectional Glenn shunt. The mean PAp ranged from 4 to 14 mmHg, while mean PVWp ranged from 3 to 15 mmHg. Mean PVWp never differed from mean PAp by more than 3 mmHg. There was a significant linear relation between mean PAp and PVWp: PAp = 0.86 (PVWp) + 2.0 (R2 = 0.89; P < 0.0001). PVWp provided a good approximation of PAp regardless of the presence (n = 2) or absence (n = 19) of antegrade pulmonary flow. There was a good linear correlation between the Rp calculated by both methods (RpPAp = 0.9 (RpVWp) + 0.5; R2 = 0.74; P < 0.0001). The mean PVWp provides a close approximation of mean PAp in children with a bidirectional Glenn shunt and provides valuable hemodynamic information in cases where direct PAp measurements are unavailable.

Pulmonary venous wedge pressures accurately predict pulmonary arterial pressures in children with single ventricle physiology.

We investigated the relationship between pulmonary venous wedge and pulmonary arterial pressures in patients with single ventricle physiology. This relationship has been studied in other cardiac conditions but not in this unique group of patients. We made 60 paired measurements from one or both lungs in 40 patients, and divided the patients into three groups. Group 1 consisted of patients whose pulmonary blood supply was via an aortopulmonary shunt (n = 14), group 2 included patients with a bi-directional Glenn anastomosis (n = 20), and group 3 included patients with a pulmonary arterial band (n = 6). Venous wedge pressure estimated arterial pressure within 3 mmHg in 59 of 60 paired measurements. Plots of the difference between pulmonary artery and pulmonary venous wedge pressures versus the mean showed excellent correlation, with a mean difference of approximately 1 for group 1 (mean difference, -0.15 +/- 1.3 mmHg) and group 2 (mean difference, 0.52 +/- 1.12 mmHg). The relationship was poor in group 3 (mean difference, -2.00 +/- 4.80 mmHg) but was much better with the exclusion of the one outlying patient in whom pulmonary venous wedge pressure significantly overestimated pulmonary arterial pressure (mean difference, -0.33 +/- 2.07 mmHg). We conclude that pulmonary venous wedge pressure accurately estimates pulmonary arterial pressure in patients palliated for single ventricle physiology, but care must be taken in patients with a pulmonary arterial band.

Relation of pulmonary venous wedge pressures to pulmonary artery pressures in patients with single ventricle physiology

Accurate assessment of pulmonary artery pressures (PAP) is important in determining the indication for Fontan procedure in patients with single ventricle physiology. However, it is sometimes difficult to measure PAP directly. Pulmonary vein wedge pressure (PVWP) may be used as an alternative to PAP in such cases. Several studies have demonstrated that PVWP correlates with PAP 1 Rao S. Sissman N.J. The relationship of pulmonary venous wedge to pulmonary arterial pressures. Circulation. 1971; 44: 565-574 Crossref PubMed Scopus (13) Google Scholar , 2 Hawker R.E. Celermajor J.M. Comparison of pulmonary artery and pulmonary venous pressures in congenital heart disease. Br Heart J. 1973; 35: 386-391 Crossref PubMed Google Scholar , 3 Waldman J.D. LaCorte M. Dick M. John S.A. Miettinen O.S. LaFarge C.G. The pulmonary venous wedge pressure in pulmonary artery hypertension. Cathet Cardiovasc Diagn. 1977; 3: 231-239 Crossref PubMed Scopus (8) Google Scholar , 4 Chern M.S. Yeh S.J. Lin F.C. Wu D. Hung J.S. Estimation of pulmonary artery pressure from pulmonary vein wedge pressure. Cathet Cardiovasc Diagn. 1994; 31: 277-282 Crossref PubMed Scopus (6) Google Scholar since a technique of catheterization for obtaining PVWP was introduced by Hellems et al. 5 Hellems H.K. Haynes F.W. Dexter L. Kinney T.D. Pulmonary capillary pressure in animals estimated by venous and arterial catheterization. Am J Physiol. 1948; 155: 98-105 PubMed Google Scholar However, these studies were based on patients with simple heart disease, and little is known about patients with complex heart disease. Accurate measurements of PAP and pulmonary vascular resistance (Rp) are critical in the selection of patients with complex heart disease for the Fontan procedure. If PVWP is used as an alternative to PAP, a small difference between PAP and PVWP could produce a big difference in the Rp, resulting in misinterpretation in determining the indication for the Fontan procedure. Thus, it is necessary to know not only the correlation between PVWP and PAP, but also to know how closely PVWP estimates PAP in patients with single ventricle physiology. The purpose of this report was to evaluate how accurately PVWP estimates PAP and to assess the relation focusing on the clinical use of PVWP as an alternative to PAP in patients who are being evaluated as Fontan candidates.

Clenbuterol administration does not enhance the efficacy of furosemide in attenuating the exercise-induced pulmonary capillary hypertension in Thoroughbred horses.

The stimulation of pulmonary beta2-adrenergic receptors causes a decrease in vascular resistance. Thus, the present study was carried out to examine whether concomitant administration of clenbuterol-a beta2-adrenergic receptor agonist, to horses premedicated with furosemide would attenuate the exercise-induced pulmonary capillary hypertension to a greater extent than furosemide alone, and in turn, affect the occurrence of exercise-induced pulmonary hemorrhage (EIPH). Experiments were carried out on six healthy, sound, exercise-trained Thoroughbred horses. All horses were studied in the control (no medications), furosemide (250 mg i.v., 4 h pre-exercise)-control, and furosemide (250 mg i.v., 4 h pre-exercise)+clenbuterol (0.8 microg/kg i.v., 11 min pre-exercise) experiments. The sequence of these treatments was randomized for every horse, and 7 days were allowed between them. Using catheter-tip-transducers whose in-vivo signals were referenced at the point of the left shoulder, pulmonary vascular pressures were determined at rest, sub-maximal exercise, and during galloping at 14.2 m/s on a 3.5% uphill grade--a workload that elicited maximal heart rate. In the control study, incremental exercise resulted in progressive significant (P<0.05) increments in heart rate, right atrial as well as pulmonary arterial, capillary and venous (wedge) pressures, and all horses experienced EIPH. Furosemide administration caused a significant (P<0.05) reduction in mean right atrial as well as pulmonary capillary and venous pressures of standing horses. Although exercise in the furosemide-control experiments also caused right atrial and pulmonary vascular pressures to increase significantly (P<0.05), the increment in mean pulmonary capillary and wedge pressures was significantly (P<0.05) attenuated in comparison with the control study, but all horses experienced EIPH. Clenbuterol administration to standing horses premedicated with furosemide caused tachycardia, but significant changes in right atrial or pulmonary vascular pressures were not discerned at rest. During exercise in the furosemide+clenbuterol experiments, heart rate, mean right atrial as well as pulmonary arterial, capillary and wedge pressures increased significantly (P<0.05), but these data were not different from the furosemide-control experiments, and all horses experienced EIPH as well. Thus, it was concluded that clenbuterol administration is ineffective in modifying the pulmonary hemodynamic effects of furosemide in standing or exercising horses. Because the intravascular force exerted onto the blood-gas barrier of horses premedicated with furosemide remained unaffected by clenbuterol administration, it is believed that concomitant clenbuterol administration is unlikely to offer additional benefit to healthy horses experiencing EIPH.

Catheterizing modified Blalock-Taussig shunts and ascending aorta to pulmonary artery shunts

Assessing the anatomy, pressure and resistance of the pulmonary vascular bed is an essential part of the preoperative evaluation of patients with congenital heart disease. In patients with pulmonary atresia or other complex defects when anterograde passage of a catheter into the pulmonary artery is not possible, pulmonary venous wedge pressures have been used to assess the pulmonary arterial pressure, and angiograms recorded close to systemic to pulmonary artery shunts have been used to assess the anatomy of the pulmonary vascular bed. These techniques often do not provide accurate information. It is preferable to directly measure pulmonary artery pressure and pulmonary vascular resistance, and perform angiography in the pulmonary artery. White 1 previously described a technique for catheterizing Blalock-Taussig (B-T) shunts (subclavian artery to pulmonary artery anastomosis) using specially preformed catheters. In this report we describe a method of retrograde catheterization of the pulmonary artery via modified B-T shunts and ascending aorta to pulmonary artery shunts. A number of catheters, Gensini (USCI, Billerica, Massachusetts), pigtail (Cordis, Miami, Florida), GL (Goodale-Lubin, USCI, Tewksbury, Massachusetts), have been used at our institution to enter such shunts. We have found that the shunts may be most easily catheterized using a Cordis Judkins 5Fr right coronary artery catheter with a 4-cm curve.

Hypoxemia in the Acute Stage of Hypertensive Intracerebral Hemorrhage, with Special Reference to Increased Extravascular Lung Water

Respiratory responses to acute brain damage have been well documented. Severe hypoxemia of unknown origin has often been seen in the acute stage of intracerebral and subarachnoid hemorrhage. Neurogenic pulmonary edema is a particular concern in the neurosurgical intensive care setting. In this study, the extravascular lung water volume (EVLW), alveolar-arterial oxygen difference (AaDO2), and intrapulmonary shunt (QS/QT) were measured in 17 patients with hypertensive intracerebral hemorrhage in the acute stage. The mean AaDO2, QS/QT, and EVLW values were 19.1 mmHg, 7.7%, and 5.49 ml/kg, respectively. The mean pulmonary arterial, central venous, and pulmonary capillary wedge pressures were all within the normal ranges. Eight patients with an AaDO2 of 20 mmHg or more manifested abnormal increases in QS/QT and EVLW, the mean values of which were 10.3% and 6.52 ml/kg, respectively. Nine patients with an AaDO2 of less than 20 mmHg exhibited normal QS/QT and EVLW, with mean values of 5.4% and 4.57 ml/kg, respectively. There was a significant, direct correlation between AaDO2 and EVLW. AaDO2 and EVLW in 11 measured cases either stayed normal or normalized within 4 weeks. These results suggest that acute congestive heart failure and/or pulmonary hypertension were not the main causes of the increase in AaDO2 and EVLW; the increase in EVLW might be explained by increased permeability of pulmonary vessels. The results of this study suggest that an increase in EVLW is causally related to hypoxemia. Further studies of lung water are necessary if we are to better understand respiratory abnormalities associated with acute-stage hypertensive intracerebral hemorrhage.

Comparatives Study of Pulmonary Artery and Pulmonary Venous Wedge Pressure in Congenital Heart Disease

Comparatives Study of Pulmonary Artery and Pulmonary Venous Wedge Pressure in Congenital Heart Disease

The pulmonary venous wedge pressure in pulmonary arterial hypertension.

AbstractThe comparability of the main pulmonary artery pressure (PAP) and the pulmonary venous wedge pressure (PVWP) was assessed during cardiac catheterization in 89 patients with pulmonary artery hypertension (PAH) and increased pulmonary blood flow. Preliminary evaluation revealed a wide disparity between the 2 determinations.Fifty‐five pull‐back pressure recordings from branch‐to‐main pulmonary artery were analyzed. Twenty‐four percent (13/55) had systolic pressure gradients &gt;20 mm Hg. between branch and main pulmonary artery. When PVWP and only ipsilateral branch PAP were compared (n=48), diastolic and mean (m), but not systolic PVWP, correlated closely with branch PAP (r=0.77, r=0.73 and r=0.59, respectively). In 46 of 48 patients the PVWPm was not significantly greater than the ipsilateral PAP. Twenty‐nine of 30 patients with PVWPm &lt;30 mm Hg. had an ipsilateral PAPm &lt;40 mm Hg. In 15 patients with PVWPm between 30 and 39 mm Hg, there was a wide range (30–59 mm Hg) of PAPm. Three patients with PVWPm &gt;40 mm Hg. had severe PAH.It is concluded that: 1) hemodynamically significant branch‐to‐main PAP gradients are present in some patients with PAH and may result in erroneously high pulmonary arteriolar vascular resistance when calculated from main PAP; 2) properly performed PVWP determination can define the lower limit of mean pressure in the ipsilateral branch pulmonary artery; 3) a PVWPm &lt;30 mm Hg. usually indicates an ipsilateral PAPm &lt;40 mm Hg; 4) a PVWPm &gt;30 mm Hg. is compatible with either moderate or severe PAH; 5) correlation of PVWP with PAP is not related to pulmonary blood flow.

Comparison of pulmonary artery and pulmonary venous wedge pressure in congenital heart disease.

Comparison of pulmonary artery and pulmonary venous wedge pressure in congenital heart disease.

The relationship of pulmonary venous wedge to pulmonary arterial pressures.

A comparison of pressure levels and pressure-time relationships in pulmonary artery pressure (PAP) and pulmonary venous wedge pressure (PVWP) tracings was made from cardiac catheterization records of 60 patients, aged 1 day to 16 years. In 50 patients with normal or low PAP's there was close correlation between systolic, diastolic, and mean pressures in the two sites. In all 10 patients with pulmonary hypertension the PVWP's were elevated but were significantly different from corresponding PAP's. The wave contours showed qualitative similarities in most cases, but the duration of the rise in systolic pressure was longer, and the Q-pressure intervals were delayed in the PVWP tracings. Satisfactory PVWP's were obtained in 42 of 67 (63%) consecutive patients approached from the leg. Lack of correlation of pressures from the two sites in the presence of pulmonary hypertension may be attributed, in part, to decreased compliance of the pulmonary arterial system. It is concluded that the PVWP is useful in catheter evaluation of heart disease: when the PVWP is normal it usually reflects accurately the PAP; an elevated PVWP suggests an elevated PAP but cannot be used reliably as an indication of the actual arterial pressure.

Relation of pulmonary arterial pressure to pressure in the pulmonary venous system.

ArticleRelation of pulmonary arterial pressure to pressure in the pulmonary venous system.T C Lloyd Jr, and A J SchneiderT C Lloyd JrSearch for more papers by this author, and A J SchneiderSearch for more papers by this authorPublished Online:01 Oct 1969https://doi.org/10.1152/jappl.1969.27.4.489MoreSectionsPDF (2 MB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations ShareShare onFacebookTwitterLinkedInWeChat Previous Back to Top Next Download PDF FiguresReferencesRelatedInformation Cited ByThe efficacy of using pulmonary vein wedge pressure for the estimation of pulmonary artery pressure in children with congenital heart disease27 January 2003 | Catheterization and Cardiovascular Interventions, Vol. 58, No. 2The Pathophysiology of Pulmonary Vascular Disease Associated with Congenital Cardiac LesionsPulmonary lymphatic flow alterations during intracranial hypertension in sheepAnnals of Neurology, Vol. 15, No. 2Experimental neurogenic pulmonary edemaJournal of Neurosurgery, Vol. 54, No. 5An analysis of the pulsatile hemodynamic responses of the pulmonary circulation to acute and chronic pulmonary venous hypertension in the awake dog.Circulation Research, Vol. 47, No. 6Centrogenic pulmonary hemorrhagic edema induced by cerebral compression in rats. Mechanism of volume and pressure loading in the pulmonary circulation.Circulation Research, Vol. 47, No. 3Supravalvular mitral stenosis associated with tetralogy of FallotThe American Journal of Cardiology, Vol. 37, No. 1Variations in pulmonary gas exchange due to changes in pulmonary artery pressure and flowJournal of Surgical Research, Vol. 18, No. 4Comparison of pulmonary artery and pulmonary venous wedge pressure in congenital heart disease.Heart, Vol. 35, No. 4Pulmonary Hypertension in Disorders of the Left Heart Observations in a Catheterization Material8 July 2009 | Scandinavian Journal of Clinical and Laboratory Investigation, Vol. 31, No. 4Hemodynamic effects of isoproterenol on the pulmonary and systemic circulations in dogsPfl�gers Archiv European Journal of Physiology, Vol. 322, No. 4Anomalous Systemic Arterial Supply to the Lung Causing Pulmonary-Artery HypertensionNew England Journal of Medicine, Vol. 283, No. 20 More from this issue > Volume 27Issue 4October 1969Pages 489-97 https://doi.org/10.1152/jappl.1969.27.4.489PubMed4390411History Published online 1 October 1969 Published in print 1 October 1969 Metrics

Effect of respiratory pressures on pulmonary pressures (including pulmonary arterial and venous wedge pressures) in the open and closed chest of the intact animal

Effect of respiratory pressures on pulmonary pressures (including pulmonary arterial and venous wedge pressures) in the open and closed chest of the intact animal

Pulmonary function in mitral valve disease: Hemodynamic and ventilatory studies

Hemodynamic and ventilatory studies were carried out in a large series of patients who underwent mitral surgery for mitral stenosis or insufficiency. A diminution of cardiac index was found, which paralleled the narrowing of the mitral orifice. However, left ventricular failure seemed to be operative in some of the cases, even in the presence of pure, tight mitral stenosis. This hypothesis was also suggested by the observation that pulmonary artery and venous wedge pressures were significantly higher in patients with combined heart failure, independently of the size of the mitral orifice. A positive linear correlation was found between pulmonary artery pressures and pulmonary vascular resistances, when the latter were more than 200 and less than 900 dynes sec cm −5. No significant increase of pulmonary blood volume could be found in patients with mitral stenosis. Lack of correlation was found between ventilatory and hemodynamic findings studied simultaneously in 50 patients. Vital capacity was significantly impaired only in decompensated patients. Residual volume was increased in every case of mitral disease. Ventilatory dynamics were also altered in every instance, particularly when congestive heart failure was present. Functional dead space was consistently increased, in spite of an increased alveolar ventilation. These findings confirm that in mitral stenosis the ventilatory perfusion ratio is consistently impaired. Results of postcommissurotomy ventilatory studies were quite variable in spite of good clinical results. In 26 patients the hemodynamic behavior was studied before and at varying intervals (30 days to 3.5 years) after mitral commissurotomy. The hemodynamic findings in patients who underwent a successful commissurotomy are similar to those observed in subjects with anatomically and functionally mild mitral stenosis.

肺循環に関する実験的並びに臨床的研究(第2報) : "Wedge Pressure"の意義について

The author have studied the significance of the "wedge pressure" in the cardiac catheterization of dogs.1) The experimental pulmonary arterial hypertension induced by pulmonary embolism does not accompany pulmonary arterial wedge pressure elevation.2) At the normal lung, contour of pulmonary venous wedge pressure showes typical arterial pressure contour, in contradiction to this, pulmonary arterial wedge pressure contour showes venous pressure contour. The pressure difference between them are averaging at 4.8 mHg.3) In the ventricular premature beats, which fails atrial contraction, pulmonary arterial wedge pressure contour showes n oa-wave and chiefly composed by v-wave.4) According to these datas, the author have set a shema, which explaines that the pulmonary arterial wedge pressure is idential with pulmonary venular pressure and the pulmonary venous wedge pressure with pulmonary arterial pressure. According to the former concept of "velocity factor" the author have calculated the pressure difference between the pulmonary arterial wedge pressure and the pulmonary venous wedge pressure as less than 0.58 mHg, which is far small as to explain practical difference of 4.8 mHg.

The interrelations of the pulmonary arterial and venous wedge pressures.

Pulmonary venous wedge pressure closely reflects the pulmonary arterial mean pressure. Pulmonary arterial wedge pressure is not significantly different from the left atrial mean pressure. Neither the former nor the latter is an approximation of the pulmonary capillary pressure.