Preoperative hemodynamic evaluation of patients submitted for major surgery

Prior to major vascular surgery, hemodynamic studies were carried out in 63 patients by means of a flow-directed pulmonary artery balloon catheter. The results were correlated to electrocardiographic and roentgenologic findings, as well as to pertinent clinical information. Of 15 patients with either atrial fibrillation or both left ventricular hypertrophy and an increased cardiace volume, six had pulmonary pressures elevated above normal values; none of 14 patients with only one of the two signs (left ventricular hypertrophy or increased cardiac volume) had elevated pulmonary pressures. Also, the 34 patients with normal roentgenologic and electrocardiographic findings had normal hemodynamics, irrespective of a history of previous AMI, present angina or dyspnea on exertion. It is concluded that hemodynamic studies by means of a balloon-tipped catheter floating in the pulmonary artery are indicated before major surgery in patients with either atrial fibrillation or both electrocardiographic and roentgenologic signs of left ventricular hypertrophy. In such patients pulmonary pressures should be monitored during and after surgical operation.