Clinical significance of portal hypertension diagnosed with bedside ultrasound after cardiac surgery
AY Denault, W Beaubien-Souligny… - Anesthesia & …, 2017 - journals.lww.com
Anesthesia & Analgesia, 2017•journals.lww.com
BACKGROUND: Portal venous flow pulsatility detected by Doppler ultrasound is a sign of
congestive heart failure in noncritically ill patients. The assessment of portal and splenic
venous flows has never been reported in patients undergoing cardiac surgery. METHODS:
This is a case series performed in patients undergoing cardiac surgery between February
2014 and February 2015 in which portal and/or splenic venous flows were assessed by the
attending anesthesiologist during surgery or by the intensivist after surgery using …
congestive heart failure in noncritically ill patients. The assessment of portal and splenic
venous flows has never been reported in patients undergoing cardiac surgery. METHODS:
This is a case series performed in patients undergoing cardiac surgery between February
2014 and February 2015 in which portal and/or splenic venous flows were assessed by the
attending anesthesiologist during surgery or by the intensivist after surgery using …
BACKGROUND:
Portal venous flow pulsatility detected by Doppler ultrasound is a sign of congestive heart failure in noncritically ill patients. The assessment of portal and splenic venous flows has never been reported in patients undergoing cardiac surgery.
METHODS:
This is a case series performed in patients undergoing cardiac surgery between February 2014 and February 2015 in which portal and/or splenic venous flows were assessed by the attending anesthesiologist during surgery or by the intensivist after surgery using transthoracic echography in 9 patients or transesophageal echocardiography in 5 patients. Data collection was done retrospectively by reviewing intraoperative and postoperative monitoring documents. The technique of assessment is detailed in this article.
RESULTS:
We report the abnormal portal and/or splenic venous flow pulsatility from 14 patients perioperatively. At the time of pulsatility detection, patients had a median cumulative fluid balance of 3.8 L (interquartile range: 0–4.6 L) and a median right atrial pressure of 14.0 mm Hg (interquartile range: 12.0–15.5 mm Hg). In some patients (4/14), signs of right ventricular dysfunction on echocardiography and/or right ventricular pressure monitoring were present.
CONCLUSIONS:
Doppler evaluation of portal and splenic venous flow using transthoracic echography and transesophageal echocardiography may represent a promising modality to assess end-organ venous congestion in cardiac surgery patients.
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