BACKGROUND: In the management of liver transplantation, massive blood loss, interruption of venous retum to the heart, sudden infusion of acidic, cold and hyperkalemic blood from the graft, and uses of inotropic and vasoactive agents make cardiac output (CO) change unpredictably. We tried to find convenient method to estimate the change of CO by mixed venous oxygen saturation (SvO2) which can be monitored by pulmonary artery catheterization with fiberoptic oximeter using a spectrophotometer, By adapting the equation of oxygen transport and oxygen consumption(VO2), the equation CO=V/O2(Hbx0.134)x1/(SaO2-SvO2) can be obtained. If we assume the VO2 and hemoglobin concentration is constant and hypoxemia is excluded, CO might be proportional to I/(100-Sv O2). METHOD: For the management of orthotopic liver transplantations in 5 mongrel dogs, we continuously monitored Sv O2 with fiberoptic pulmonary catheter and intermittently measured the CO by thermodilution method according to operative phases. The Pearsons correlation coefficients between CO and mean arterial pressure, CO and S vO. and CO and 1/(100 SvO2) were measured in each dog. RESULT: The correlation coefficients between CO and 1/(100 SvO2) are raging from 0.74 to 0.98 with a corrected mean of 0.847 and significant in all dogs (p<0.05), and the correlation coefficients between CO and SvO2 are ranging from 0.67 to 0.96 with a corrected means of 0.786 and significant in 4 of 5 dogs. CONCLUSIONS: For the management of liver transplantation, the continuous monitoring of mixed venous oxygen saturation by a fiberoptic pulmonary catheter is helpful to detect changes of cardiac output.
Animals ; Anoxia ; Arterial Pressure ; Cardiac Output* ; Catheterization, Swan-Ganz ; Catheters ; Dogs* ; Heart ; Liver Transplantation* ; Liver* ; Oxygen* ; Rage ; Thermodilution ; Transplants

Blunt trauma of the chest and abdomen frequently result in cardiac injury. We experienced a 47 year-old male patient of myocardial contusion with aortic insufficiency after blunt chest trauma. On the secondd day after admission, the patient developed sudden hypoxemia and wide pulse pressure. A pulmonary arterial catheter was inserted and initial cardiac output and pulmonary capillary wedge pressure was 3.56 L/min/m(2) and 32 mmHg, respectively. There was akinesia of the anterior septum, anterior wall, inferior wall and inferior septum with aortic regurgitation(I/IV), and the ejection fraction was 25% on echocardiogram. Myocardial contusion with valvular injury was suspected. Dobutamine infusion was started and after five days the pulmonary capillary wedge pressure was decreased to 14 mmHg. The ejection fraction was increased to 69% in spite of decreasing dobutamine but aortic regurgitation(II/VI) remained. Therefore echocardiogram and pulmonary artery catheterization will be helpful to diagnose suspected cardiac contusion and for better outcome.
Abdomen ; Anoxia ; Blood Pressure ; Cardiac Output ; Catheterization, Swan-Ganz ; Catheters ; Contusions ; Dobutamine ; Heart ; Humans ; Male ; Middle Aged ; Pulmonary Wedge Pressure ; Thorax*

Hemodynamic monitoring is an essential element in the management of perioperative patients. In addition, anesthesiologists routinely used blood pressure (invasive or non invasive), heart rate, urinary output and central venous pressure as monitoring modalities. Esophageal doppler monitoring, as a minimally invasive hemodynamic assessment tool, has a good correlation with pulmonary artery catheterization in measuring cardiac output. We experienced a case of concealed retroperitoneal hemorrhage in a patient who underwent a laparoscopic subtotal gastrectomy. When surgeons tried to close trocar sites, the patient's blood pressure dropped rapidly. At laparoscopy, we could not find gross bleeding. However, we could detect hypovolemia by esophageal doppler monitoring (CardioQ, Deltex(TM), UK). The procedure was converted to open laparotomy. Thereafter, we could find retroperitoneal hemorrhage, and vascular repair was done successfully. The patient recovered without any other complications.
Blood Pressure ; Cardiac Output ; Catheterization, Swan-Ganz ; Central Venous Pressure ; Gastrectomy ; Heart Rate ; Hemodynamics ; Hemorrhage ; Humans ; Hypovolemia ; Laparoscopy ; Laparotomy ; Surgical Instruments

The purposes of central venous catheterization (CVC) are as followings, central venous pressure monitoring, pulmonary artery catheterization and monitoring, transvenous cardiac pacing, temporary hemodialysis, drug administration, rapid infusion of fluids, aspiration of air embolism. Various complications may occur during CVC, such as hematoma, pneumothorax, hemothorax, hydrothorax, chylothorax, nerve and artery injury, air embolism, thromboembolism, arrhythmia, heart block, cardiac tamponade, and tracheal puncture. In Korea, several complications have been reported after CVC, such as pneumothorax, hemothorax, hemomediastinum, cardiac tamponade and tracheal puncture. However, there has been no report about the knotting of J-guide wire during the CVC. We report a case of J-guide wire knotting during central venous catheterization.
Arrhythmias, Cardiac ; Arteries ; Cardiac Tamponade ; Catheterization, Central Venous* ; Catheterization, Swan-Ganz ; Central Venous Catheters* ; Central Venous Pressure ; Chylothorax ; Embolism, Air ; Heart Block ; Hematoma ; Hemothorax ; Hydrothorax ; Korea ; Pneumothorax ; Punctures ; Renal Dialysis ; Thromboembolism

To evaluate effects of IPV (Intrapulmonary Percussive Ventilation) on cardiopulmonary hemodynamics and oxygenation, we compared IPV with conventional IPPV (Intermittent Positive Pressure Ventilation} in eight mongrel dogs. After Swan-Ganz catheterization and femoral arterial cannulation, we applied IPPU and IPV for 30 minutes respectively at random order. There were no significant differences in cardiac output (CO), heart rate (HR), mean arterial pressure (MAP), vascular resistance (VR), pulmonary capillary wedge pressure (PCWP), rate pressure product (RPP), coronary perfusion pressure (CPP) and oxygenation-reflecting parameters such as AaDO2, oxygen flux and oxygen consumption (VO2) between IPPV and IPV. A slight increase of diastolic pulmonary arterial pressure (PAP) resulted in increase of pulmonary perfusion pressure (PPP). IPV increases left and right ventricular stroke work index which might be related to slight metabolic acidosis and a little deficient ventilation during IPV. We can conclude that IPV is safe and good in cardiopulmonary hemodynamics and tissue oxygena-tion in dogs, but its better to be cautious in ventilation during IPV.
Acidosis ; Animals ; Arterial Pressure ; Cardiac Output ; Catheterization ; Catheterization, Swan-Ganz ; Dogs* ; Heart Rate ; Hemodynamics* ; Intermittent Positive-Pressure Ventilation ; Oxygen Consumption ; Oxygen* ; Perfusion ; Pulmonary Wedge Pressure ; Stroke ; Vascular Resistance ; Ventilation*

BACKGROUND AND OBJECTIVES: As mitral stenosis worsens, the cardiac output can be reduced, with a compensatory increase in the sympathetic nervous activity. An accelerated sympathetic nervous activity is responsible for various pathophysiological changes, including atrial thrombus formation, pulmonary congestion and myocardial ischemia. In this study, the sympathetic nervous activity was evaluated in patients with rheumatic mitral valvular stenosis, both before and after a percutaneous mitral balloon valvuloplasty (PMV). SUBJECTS AND METHODS: A PMV was successfully performed in 19 patients with mitral stenosis. The hemodynamic data were obtained by Swan-Ganz catheterization, and the variability in the heart rate evaluated by time domain measure via 24-hour ECG monitoring. An exercise test was performed according to Chung's exercise protocol, with the plasma norepinephrine level obtained before, during and after exercise. RESULTS: After the PMV, the right ventricle systolic, mean pulmonary arterial, pulmonary capillary wedge and left atrial pressures were significantly decreased. However, there were no significant changes in the right atrial, right ventricle end-diastolic and left ventricle end-diastolic pressures. After the PMV, the plasma norepinephrine level, an indicator of the sympathetic activity, was significantly decreased. On the other hand, the variability in heart rate, indicator of parasympathetic activity, was significantly decreased. CONCLUSION: In patients with mitral valvular stenosis, the sympathetic activity is accelerated, while the parasympathetic activity is decreased. This situation can be immediately reversed after a successful PMV.
Atrial Pressure ; Balloon Valvuloplasty* ; Capillaries ; Cardiac Output ; Catheterization, Swan-Ganz ; Constriction, Pathologic ; Electrocardiography ; Estrogens, Conjugated (USP) ; Exercise Test ; Hand ; Heart Rate ; Heart Ventricles ; Hemodynamics ; Humans ; Mitral Valve Stenosis* ; Myocardial Ischemia ; Norepinephrine ; Plasma ; Sympathetic Nervous System ; Thrombosis

PURPOSE: To investigate the accuracy, precision and validity of fever detection of tympanic membrane (TM), temporal artery (TA) and axillary temperature (AT) compared with pulmonary artery temperature (PA). METHODS: Repeated-measures design was conducted for one year on 83 adult cardiac care unit patients with pulmonary artery catheters after open heart surgery. Sequential temperature measurements were taken three times at 20-minute intervals. Accuracy, precision, repeatability, and validity of fever detection were analyzed. RESULTS: Mean pulmonary artery temperature was 37.04degrees C (SD 0.70degrees C). The mean (SD) offsets from PA, with the mean reflecting accuracy and SD reflecting precision, were -1.31degrees C (0.75degrees C) for TA, -0.20degrees C (0.24degrees C) for TM, and -0.97degrees C (0.64degrees C) for AT. Percentage of pairs with differences within +/-0.5degrees C was 9.6% for TA, 19.7% for AT, and 91.6% for TM. Repeated measurements with all three methods had mean SD values within 0.04degrees C. Sensitivity, specificity, and positive and negative predictive values of tympanic measurements were 0.76, 1.0, and 1.0, and 0.90, respectively. CONCLUSION: Results show that TM best reflects PA, and is most consistent, accurate, and precise. AT tends to underestimate PA, and TA is least accurate and precise. Therefore tympanic membrane measurement is a reliable alternative to other non-invasive methods of measuring temperatures.
Aged ; Axilla/physiology ; Body Mass Index ; *Body Temperature ; Cardiac Care Facilities ; Catheterization, Swan-Ganz ; Female ; Fever/*diagnosis ; Heart Diseases/surgery ; Humans ; Male ; Middle Aged ; Pulmonary Artery/physiology ; Temporal Arteries/physiology ; Thermometers ; Tympanic Membrane/physiology

BACKGROUND: Mixed venous oxygen saturation (SO2) monitoring turned out to be invaluable in following up systemic cardiovascular status. But balloon-tipped flow-directed thermodilution catheter (Swan-Ganz catheter) insertion carries additional inherent risks other than those of central venous catheterization, and it costs much more expense than simple venous catheter. There has been a lot of papers which argue that central venous catheterization may substitute for the Swan-Ganz catheterization. In addition, it may be very difficult or impossible to insert the Swan-Ganz catheter in pediatric patients. This study was performed to determine whether Swan-Ganz catheterization might be replaced by the central venous catheterization in regards to SO2. METHODS: In 17 pediatric open heart surgery (OHS) patients, from the central venous catheter, the tip of which had been located in the center of right atrium (RA) and pulmonary artery, blood samples were drawn for gas analysis simultaneously, which was done immediately after emergence from cardiopulmonary bypass. RESULTS: There were no significant differences between RA blood and mixed venous blood gas analyses except oxygen saturation. The oxygen saturations of both were linearly correlated with each other. The relation was SO2=17 0.8 SRAO2 (R=0.77, p<0.05) CONCLUSIONS: It may be concluded that RA blood may be used for blood gas analysis in place of mixed venous blood immediately after pediatric open heart surgery.
Blood Gas Analysis ; Cardiopulmonary Bypass* ; Catheterization, Central Venous ; Catheterization, Swan-Ganz ; Catheters ; Central Venous Catheters ; Heart Atria ; Heart* ; Humans ; Oxygen* ; Pulmonary Artery ; Thermodilution ; Thoracic Surgery*

We report an extremely rare case of right ventricle perforation by a Swan-Ganz catheter during open heart surgery. Even when pulmonary artery catheters are inserted with the utmost care, serious complications such as hematoma formation, pneumothorax, hemothorax, perforation of the cardiac chambers, and rupture of the pulmonary artery may occur. We present a case of primary closure of a right ventricle perforation discovered during coronary artery bypass graft surgery. In this case, the Swan-Ganz catheter was found penetrating the anterior wall of the right ventricle during the surgery. The location of the Swan-Ganz catheter, the stiffness of the catheter caused by hypothermia, and excessive surgical manipulation were supposed to be the etiologies. Therefore, the location of the Swan-Ganz catheter and increased stiffness from hypothermia should be taken into consideration during heart surgery.
Catheterization, Swan-Ganz* ; Catheters ; Coronary Artery Bypass ; Heart Ventricles* ; Hematoma ; Hemothorax ; Humans ; Hypothermia ; Pneumothorax ; Pulmonary Artery ; Rupture ; Thoracic Surgery ; Transplants

Case 1: A 30-year-old woman was scheduled for mitral valvuloplasty. A pulmonary artery (PA) catheter (Swan-Ganz CCOmbo model: 744HF75, Edwards(r), USA) was inserted via an introducer (8.5 Fr) placed in the right external jugular vein. The tip of the catheter could not be passed from the external jugular vein to the subclavian vein. When we attempted to advance the PA catheter again 30 minutes later, it could not be advanced or withdrawn. The PA catheter was removed with an introducer. The tip of the introducer had curled up into the intralummial space and the PA catheter had impacted in the narrowed lumen. Case 2: A 48-year-old woman was scheduled for tricuspid annuloplasty. A PA catheter was inserted via an introducer placed in the right internal jugular vein without problem. After opening the right atrium and withdrawing the PA catheter, a vinyl strip was found to have torn away from the distal part of the PA catheter.
Adult ; Catheterization, Swan-Ganz* ; Catheters ; Female ; Heart Atria ; Humans ; Jugular Veins ; Middle Aged ; Pulmonary Artery* ; Subclavian Vein