Upper Extremity Peripheral Venous Pressure Measurements Accurately Reflect Pulmonary Artery Pressures in Patients with Cavopulmonary or Fontan Connections

Abstract

After the bidirectional cavopulmonary or Fontan operation, the physiologic consequence is passive flow of the systemic venous return to the pulmonary arteries. Knowledge of pulmonary artery pressure (PA) is valuable in the management of these patients, and obtaining this information without the need for a central line or cardiac catheterization would be advantageous. The aim of this study was to evaluate the correlation between upper extremity peripheral venous (PV) pressures and PA or superior vena cava (SVC) pressures in patients who have undergone cavopulmonary or Fontan connections. During cardiac catheterization, 19 patients with complex cyanotic heart disease who had undergone a cavopulmonary shunt or Fontan procedure were studied. Simultaneous pressure measurements were obtained from the peripheral intravenous line placed prior to the procedure and the SVC or PA. The mean pressures were compared. The mean PV pressure was 17.5 +/- 5.6 mmHg. The mean SVC or PA pressure was 16.1 +/- 5.4 mmHg. The mean difference was 1.5 +/- 1.5 mmHg ( p < 0.001). The correlation coefficient PV to SVC or PA pressure was 0.97 ( p < 0.001). PV pressure measurements taken from an upper extremity accurately reflect PA pressures in patients who have undergone a cavopulmonary shunt or Fontan procedure.

Noninvasive Assessment of Pulmonary Artery Pressure in Patients with Extracardiac Conduit Total Cavopulmonary Connection

“…Milhon et al investigated correlation of peripheral vein pressure and PAP in patients with Glenn Shunt and Modified Fontan. They presented excellent correlation (correlation coefficient = 0.97, p value \ 0.001) in patients without stenosis in pathway [22].In our study, a very good linear Pearson correlation coefficient ?0.9 (P \ 0.0001) between peripheral vascular pressure and central and pulmonary artery pressure was also defined. In all cases, peripheral vein pressure was more than PAP; peripheral pressure more than 17 mmHg with 100 % sensitivity and 76 % specificity indicates PAP C 17 mmHg, and peripheral pressure [ 20 mmHg is 100 % specific for PAP C 17.…”

Assessment of central venous physiology of Fontan circulation using peripheral venous pressure

“…22 In contrast, one previous study performed in patients with single ventricular circulation showed an excellent correlation between the 2 pressures. 24 Although the study included only 9 Fontan cases, PVP and CVP in a total of 19 patients including 10 Glenn cases were highly correlated (R ¼ 0.97), and the difference between PVP and CVP was small (1.5 AE 1.5 mm Hg). The present results conducted in Fontan cases were consistent with the study by Milhoan and colleagues 24 in that correlation between PVP and CVP is better and differences between the 2 pressures are smaller than in previous reports in biventricular circulation.…”

“…24 Although the study included only 9 Fontan cases, PVP and CVP in a total of 19 patients including 10 Glenn cases were highly correlated (R ¼ 0.97), and the difference between PVP and CVP was small (1.5 AE 1.5 mm Hg). The present results conducted in Fontan cases were consistent with the study by Milhoan and colleagues 24 in that correlation between PVP and CVP is better and differences between the 2 pressures are smaller than in previous reports in biventricular circulation. It was reported that the difference between PVP and CVP decreases with increasing CVP in biventricular circulation, 25 and the mechanism was proposed that high CVP prevents venous collapse.…”

“…It was reported that the difference between PVP and CVP decreases with increasing CVP in biventricular circulation, 25 and the mechanism was proposed that high CVP prevents venous collapse. 25 In this aspect, the current study and the study of Milhoan and colleagues 24 were conducted in patients with superior vena caval-pulmonary connection in which high CVP is mandatory 26,27 and appears to induce venous distension and reduce venous resistance. Of note, the abolition of the pressure difference between venous systems was first seen in another region of interest in the Fontan venous physiology: the splanchnic circulation.…”

Anesthetic Management of Pheochromocytoma Resection in Adults with Single Ventricle Physiology

“…It is important to note that the pressures obtained from central venous access essentially reflect pulmonary artery pressures in this patient population. An alternative method validated to measure pulmonary artery pressures in patients with unobstructed cavopulmonary or Fontan connections is by transducing pressure from an upper extremity [ 10 ]. Although this method avoids the potential complication of thrombosis at the Glenn anastomosis, accurate measurements rely on an unobstructed path from the peripheral vein to the pulmonary artery, and is limited in patients who have significant veno-venous collaterals [ 10 ].…”