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Canadian Journal of Anesthesia, Vol 32, 165-170, Copyright © 1985 by Canadian Anesthesiologists' Society

Increased Pulmonary Artery Diastolic-Pulmonary Wedge Pressure Gradient After Cardiopulmonary Bypass

JUSSI HEINONEN MD1, MARKKU SALMENPERÄ MD1, and OLLI TAKKUNEN MD1

1 Cardiothoracic Anaesthesia Group, Department of Anaesthesia, Helsinki University Central Hospital, Helsinki, Finland

Address correspondence to: Dr. J. Heinonen, Dept. of Anaesthesia, Helsinki University Central Hospital, Haartmaninkatu 4, SF-00290 Helsinki 29, Finland.

In 29 patients undergoing elective coronary artery bypass grafting, the diastolic pulmonary arterial pressure-pulmonary capillary wedge pressure gradient (DPAP-PCWP) and related haemodynamic parameters were determined before and after induction of anaesthesia, immediately after cardiopulmonary bypass (CPB) and one and three hours after CPB. The DPAP-PCWP gradient remained unchanged after induction of anaesthesia but was significantly increased after CPB. A gradient of 5 mmHg or greater was observed in 16 patients after CPB, whereas none of the patients showed such a gradient before CPB. A significant correlation was found between the change in DPAP-PCWP and the change in pulmonary vascular resistance (PVR). It is concluded that DPAP should not be used as a substitute of PCWP in the early postbypass period without frequent confirmation of the presence of the normal small DPAP-PCWP gradient. Since an increase of PVR may impair right ventricular ejection, we recommend the routine measurement of DPAP-PCWP gradient in the postbypass period.

Key Words: LUNG: intravascular pressures, vascular resistance • SURGERY: cardiac • MONITORING: blood pressure, pulmonary artery pressure






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Copyright © 1985 by the Canadian Anesthesiologists' Society.