Monitoring Left Atrial Pressure With a Useful Epidural Catheter

Keywords: Left atrial monitoring, left atrial pressure, complex congenital heart defects, epidural catheter

Abstract

Background: Left atrial pressure (LAP) monitoring provides a valuable option for management of hemodynamic status in pediatric congenital heart surgery during the postoperative period.

Methods: We used a Perifix Soft Tip 701 filter set catheter (B. Braun Melsungen AG 34209 Melsungen, Germany), which is commonly used for continuous epidural anesthesia. The catheter was placed into the left atrium to provide LAP monitoring. The study included 33 children, who needed LAP monitoring during and post-surgery between January 2016 and September 2017. Patients retrospectively were reviewed for ease of catheter placement, effectivity, accurate LAP, postoperative stability, and complications after removal of the catheter, including bleeding, air embolism, or thromboembolic events.

Results: Patients ranged in age from 2 days to 131.27 months (Mean 11.80 days ± 25.76 days). Fifteen patients were newborn. Of the newborn patients, 39.4% (N = 13) were female. Catheters successfully were implanted in all patients, and there were no procedural complications. Left atrial catheters were removed between 1 to 12 days, with an average of 3.55 days ± 3.39 days before chest tube removal. During follow-up, patients did not suffer complications, such as thrombus formation, catheter-related infection, systemic embolism or stroke. Also, after the catheter was withdrawn, patients did not suffer from bleeding, haemodynamic deterioration, catheter retention, or require the need for intervention. During the stay in ICU, catheter nonfunction was the most frequent complication at 12.1 percent (N = 4). 

Conclusion: This is a simple, easy, and safe technique for wide use in congenital cardiac surgery patients.

References

Ceyran H, Akçali Y, Asgun F, Tezcaner T, Tasdemir K, Emirogullari ON, Ersepciler M. 2003. Benefit of using a triple-lumen catheter to monitor left atrial pressure. Acta Anaesthesiol Scand 47:430–2.

Ding J, Zhang Q, Li L, et al. 2016. A Novel Combined-Catheter to Monitor Left and Right Atrial Pressures. Pediatr Crit Care Med 17:210–5.

Flori HR, Johnson LD, Hanley FL, Fineman JR. 2000. Transthoracic intracardiac catheters in pediatric patients recovering from congenital heart defect surgery: Associated complications and outcomes 28:2997–3001.

Fukutome T, Kohjiro M, Sese A, Ueno Y. 1993. Trans-septal left atrial catheterisation. Anaesthesia 48:407–8.

Gold JP, Jonas RA, Lang P, Elixson EM, Mayer JE, Castaneda AR. 1986. Transthoracic intracardiac monitoring lines in pediatric surgical patients: A ten-year experience. Ann Thorac Surg 42:185–91.

Haider W, Zwolfer W, Hiesmayr M, et al. 1993. Improved cardiac performance and reduced pulmonary vascular constriction by epinephrine administration via a left atrial catheter in cardiac surgical patients. J Cardiothorac Vasc Anesth 7:684–7.

Mondejar EF, Torres JM, Moreno T, Vazquez G. 1988. The use of left atrial catheter after cardiac surgery. Intensive Care Med 14:441–2.

Rao PS, Sathyanarayana PV. 1993. Transseptal insertion of left atrial line: A simple and safe technique. Ann Thorac Surg 55:785–6.

Salihoğlu E, Gursoy M, Ozcobanoglu S, Ozkan S. 2013. Safety of surgical pulmonary artery catheters in pediatric patients. Turkish J Thorac Cardiovasc Surg 21:300–4.

Ueno Y, Sese A, Toshima Y, Fukutome T. 1993. Transvenous monitoring of left atrial and central venous pressure with a double-lumen catheter. Kyobu Geka 944–6.

Zahorec R, Holoman M. 1997. Transatrial access for left atrial pressure monitoring in cardiac surgery patients. Eur J Cardiothorac Surg 11:379–80.

Published
2018-06-14
Section
Articles