Monitoring pulmonary artery pressure in children undergoing the Fontan procedure.

Abstract

OBJECTIVE:

To compare external and internal jugular venous pressures to monitor pulmonary artery pressure during the Fontan procedure.

BACKGROUND:

During the Fontan procedure, the internal jugular vein is used to assess pulmonary artery pressure. The risk of venous thrombosis in the low-pressure Fontan circuit may compromise the long-term success of cavopulmonary anastomosis. This study compared external and internal jugular venous pressures, femoral venous pressure, and actual pulmonary artery pressure during the Fontan procedure.

METHOD:

32 children undergoing a single-stage Fontan on cardiopulmonary bypass were monitored for mean external and internal jugular venous pressures and femoral venous pressure pre- and post-cardiopulmonary bypass. Pulmonary artery pressure was also recorded directly after cardiopulmonary bypass. The pressure data were analyzed using analysis of variance, and the coefficient of correlation was found.

RESULTS:

The differences between external jugular, internal jugular, and femoral venous pressure pre-cardiopulmonary bypass, and between the 3 venous pressures and the pulmonary artery pressure after cardiopulmonary bypass were found to be non-significant. The coefficient of correlation of external jugular venous pressure and internal jugular venous pressure was 0.8163 (p < 0.0001) pre-cardiopulmonary bypass, and 0.6465 (p = 0.0001) post-cardiopulmonary bypass.

CONCLUSION:

The external jugular venous pressure correlates well with both internal jugular venous pressure and femoral venous pressure as a marker of pulmonary artery pressure in children undergoing the Fontan procedure. The use of external jugular venous pressure may also preclude the risk of thrombosis.

• Authors: Sumit Vasdev, Sandeep Chauhan, Sachin Talwar, Anil Pandey, Usha Kiran
• Journal: Asian cardiovascular & thoracic annals (Asian Cardiovasc Thorac Ann) Vol. 21 Issue 3 Pg. 303-5 (Jun 2013) ISSN: 1816-5370 [Electronic] England
• PMID: 24570496 (Publication Type: Comparative Study, Journal Article)

Topics

• Age Factors
• Arterial Pressure
• Blood Pressure Determination
• Cardiopulmonary Bypass
• Central Venous Pressure
• Child
• Child, Preschool
• Femoral Vein (physiopathology)
• Fontan Procedure (adverse effects)
• Heart Defects, Congenital (diagnosis, physiopathology, surgery)
• Humans
• Jugular Veins (physiopathology)
• Monitoring, Intraoperative (methods)
• Predictive Value of Tests
• Pulmonary Artery (physiopathology)
• Risk Factors
• Time Factors
• Treatment Outcome
• Venous Thrombosis (etiology, physiopathology, prevention & control)