• Anesthesia and analgesia · Apr 2017

    Clinical Significance of Portal Hypertension Diagnosed With Bedside Ultrasound After Cardiac Surgery.

    • André Y Denault, William Beaubien-Souligny, Mahsa Elmi-Sarabi, Roberto Eljaiek, Ismail El-Hamamsy, Yoan Lamarche, Alexandra Chronopoulos, Jean Lambert, Josée Bouchard, and Georges Desjardins.
    • From the *Department of Anesthesia and †Intensive Care Unit, Research Centre, Montreal Heart Institute and Université de Montréal, Montreal, Quebec; ‡Department of Nephrology and §Department of Medicine, and Université de Montréal, Montreal, Quebec; ‖Department of Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Quebec; ¶Department of Social and Preventive Medicine, Université de Montréal, Montreal, Quebec; and #Department of Nephrology, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec.
    • Anesth. Analg. 2017 Apr 1; 124 (4): 1109-1115.

    BackgroundPortal 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.MethodsThis 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.ResultsWe 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.ConclusionsDoppler 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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