Monitoring Pulmonary Arterial Pressure in Coronary-artery Disease

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Abstract
To delineate the indications for pulmonary arterial pressure monitoring, the relationship between central venous pressure (CVP) and pulmonary capillary wedge pressure (PCWP) was examined in 30 patients with coronary-artery disease and ventricular dysfunction (ejection fractions ranging from 0.26-0.84) prior to, during and after coronary-artery surgery. For each patient, 30 simultaneous measurements of CVP and PCWP were made during 36 h that included the awake state, the anesthetized state with and without surgery, before and after pericardiotomy, before and after cardiopulmonary bypass and 1, 4, 8 and 24 h after operation. Changes in filling pressures were acutely induced by changing body position to alter venous return. The CVP ranged from 0-19 torr, and the PCWP from 0-31 torr. The CVP and the PCWP correlated well (r = 0.89) during all measurement periods for patients who had ejection fractions greater than 0.50 without angiographically demonstrable ventricular dyssynergy preoperatively. Changes in CVP (.DELTA.CVP) and PCWP (.DELTA.PCWP) over the 36 h period also correlated well (r = 0.94). Normality (abnormality) of the CVP was predictive of normality (abnormality) of the PCWP for more than 96% of the 450 data points. For patients with ejection fractions less than 0.40 or with dyssynergy, the CVP did not correlate with the PCWP (r = 0.24), and .DELTA.CVP did not correlate with .DELTA.PCWP (r = 0.04). Normality (abnormality) of the CVP was predictive of normality (abnormality) of the PCWP for less than 62% of the 450 data points.

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