Pulmonary Hemodynamics in Patients with Pulmonary Hypertension Undergoing Repair of Atrial or Ventricular Septal Defect and Mitral Valve Replacement.

Lim,  Hyun Kyo; Lee,  Kwang Ho; Kwak,  No Kil; Lee,  Choon Soo; Kwak,  Young Lan; Lee,  Eun Sook; Bang,  Sou Ouk; Hong,  Yong Woo

doi:1997.32.1.116

Clinical Research Article

Korean Journal of Anesthesiology 1997;32(1):116-121.
DOI: https://doi.org/10.4097/kjae.1997.32.1.116

Pulmonary Hemodynamics in Patients with Pulmonary Hypertension Undergoing Repair of Atrial or Ventricular Septal Defect and Mitral Valve Replacement.

Hyun Kyo Lim, Kwang Ho Lee, No Kil Kwak, Choon Soo Lee, Young Lan Kwak, Eun Sook Lee, Sou Ouk Bang, Yong Woo Hong

¹Department of Anesthesiology, Yonsei University Wonju College of Medicine, Wonju, Korea.
²Department of Anesthesiology, Inha University College of Medicine, Incheon, Korea.
³Department of Anesthesiology, Yonsei Cardiovascular Center and Research Institute, Yonsei University College of Medicine, Seoul, Korea.

Abstract

BACKGROUND
The mechanisms of pulmonary hypertension(PHT) are usually quite different in acquired disorders of the left side of the heart from those of congenital heart disease. Accordingly, this study was designed to compare pulmonary hemodynamics immediately after cardiopulmonary bypass(CPB) in patients with undergoing repair of atrial(ASD) or ventricular septal defect(VSD) and mitral valve replacement(MVR).
METHODS
49 patients with PHT defined as a resting systolic pulmonary arterial pressure(SPAP) greater than 35 mmHg were studied and were divided preoperatively into two groups; repair of ASD or VSD(Group I, n=18) and MVR(Group II, n=31). Measurements were made after sternotomy and prior to initiation of CPB and upon stabilization following discontinuation of CPB.
RESULTS
In group I, SPAP, DPAP and MPAP decreased by 44%, 22% and 35% respectively and pulmonary vascular resistance index(PVRI) decreased by 47% after CPB. In group II, SPAP, DPAP and MPAP revealed 25%, 32% and 29% reduction respectively and PVRI decrease by 39% after CPB. SPAP decreased more significantly after CPB in group I(44% vs 25%, p<0.05). CI increased significantly in group II while decreased in group I. Intraoperative inotropes and vasodilators were used more in group II than in group I(24/31 vs 6/18).
CONCLUSIONS
The successful replacement of the valve and patch repair of defect may reduce both PAP and PVRI moderately in patients with PHT.

Key Words: Blood pressure pulmonary hypertension; Surgery cardiac; Heart cardiopulmonary bypass; Monitoring pulmonary hemodynamics