Interatrial Septum Motion but Not Doppler Assessment Predicts Elevated Pulmonary Capillary Wedge Pressure in Patients Undergoing Cardiac Surgery

Haji, Darsim; Ali, Mohamed Mandour; Royse, Alistair; Canty, David; Clarke, Sandy; Royse, Colin

doi:10.1097/aln.0000000000000392

Cited by 20 publications

(19 citation statements)

References 30 publications

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“…Left ventricular systolic dysfunction was defined as systolic fractional reduction in LV internal dimension less than 24% or a reduction in LV end diastolic area less than 50%. Left ventricular diastolic dysfunction was defined as normal LV systolic function with raised left atrial pressure determined by the presence of a fixed curvature of the interatrial septum towards the right atrium, as demonstrated by Haji et al [22]. Right ventricular dysfunction was defined using ultrasound as dilation of the RV end-diastolic area to greater than two-thirds of the LV end-diastolic area and reduced RV free wall motion with or without flattening of the interventricular septum.…”

Section: Methodsmentioning

confidence: 99%

Pilot multi‐centre randomised trial of the impact of pre‐operative focused cardiac ultrasound on mortality and morbidity in patients having surgery for femoral neck fractures (ECHONOF‐2 pilot)

et al. 2017

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Hip fracture surgery is common, usually occurs in elderly patients who have multiple comorbidities, and is associated with high morbidity and mortality. Pre-operative focused cardiac ultrasound can alter diagnosis and management, but its impact on outcome remains uncertain. This pilot study assessed feasibility and group separation for a proposed large randomised clinical trial of the impact of pre-operative focused cardiac ultrasound on patient outcome after hip fracture surgery. Adult patients requiring hip fracture surgery in four teaching hospitals in Australia were randomly allocated to receive focused cardiac ultrasound before surgery or not. The primary composite outcome was any death, acute kidney injury, non-fatal myocardial infarction, cerebrovascular accident, pulmonary embolism or cardiopulmonary arrest within 30 days of surgery. Of the 175 patients screened, 100 were included as trial participants (screening:recruitment ratio 1.7:1), 49 in the ultrasound group and 51 as controls. There was one protocol failure among those recruited. The primary composite outcome occurred in seven of the ultrasound group patients and 12 of the control group patients (relative group separation 39%). Death, acute kidney injury and cerebrovascular accident were recorded, but no cases of myocardial infarction, pulmonary embolism or cardiopulmonary arrest ocurred. Focused cardiac ultrasound altered the management of 17 participants, suggesting an effect mechanism. This pilot study demonstrated that enrolment and the protocol are feasible, that the primary composite outcome is appropriate, and that there is a treatment effect favouring focused cardiac ultrasound - and therefore supports a large randomised clinical trial.

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Section: Methodsmentioning

confidence: 99%

Pilot multi‐centre randomised trial of the impact of pre‐operative focused cardiac ultrasound on mortality and morbidity in patients having surgery for femoral neck fractures (ECHONOF‐2 pilot)

et al. 2017

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“…In extreme conditions, severely impaired ventricular filling can be visualized as 'kissing walls' when the papillary muscles touch each other at end-systole corresponding to full emptying of the ventricle (parasternal short-axis view). Conversely, a high left ventricular filling pressure will facilitate a fixed bulging of the interatrial septum into the right atrium [33].…”

Section: Preloadmentioning

confidence: 99%

Transthoracic echocardiography in the perioperative setting

Jørgensen¹,

Juhl-Olsen²,

Frederiksen

et al. 2016

Current Opinion in Anaesthesiology

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Hemodynamically significant cardiac disease or pathophysiology can be disclosed using TTE. Focused TTE is feasible for perioperative patient management and monitoring and will be an inevitable and indispensable tool for the anesthetist. Future research should focus on the outcome of perioperative TTE performed by anesthetists, using rigorous study designs and patient-centered outcomes such as mortality and morbidity.

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“…The interatrial septum should be examined as its motion correlates with filling pressure. 22,23 This is also an excellent view to assess the permeability of a patent foramen ovale by performing a bubble contrast study. Moving the ultrasound beam upward, a view of the RVOT can be obtained with the origin of the pulmonary valve.…”

Section: The Parasternal Viewsmentioning

confidence: 99%

Transthoracic echocardiographic evaluation of the heart and great vessels

Denault

Langevin

Lessard

et al. 2018

Can J Anesth/J Can Anesth

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Interatrial Septum Motion but Not Doppler Assessment Predicts Elevated Pulmonary Capillary Wedge Pressure in Patients Undergoing Cardiac Surgery

Abstract: Doppler assessment of PCWP was neither sensitive nor specific enough to be clinically useful in anesthetized patients with mechanical ventilation. The fixed curve pattern of the interatrial septum was the best predictor of raised PCWP.

Cited by 20 publications

References 30 publications

Pilot multi‐centre randomised trial of the impact of pre‐operative focused cardiac ultrasound on mortality and morbidity in patients having surgery for femoral neck fractures (ECHONOF‐2 pilot)

Pilot multi‐centre randomised trial of the impact of pre‐operative focused cardiac ultrasound on mortality and morbidity in patients having surgery for femoral neck fractures (ECHONOF‐2 pilot)

Transthoracic echocardiography in the perioperative setting

Transthoracic echocardiographic evaluation of the heart and great vessels

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