Monitoring Left Atrial Pressure With a Useful Epidural Catheter

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

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.

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 Also, after the catheter was withdrawn, patients did not suffer from bleeding, haemodynamic deterioration, catheter retention, or require the need for intervention.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).

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