Factors influencing the character of the pulmonary arterial wedge pressure

Appraisal of the contour of pulmonary wedge pressure curves of sixty-three human subjects with normal hemodynamics, rheumatic valvular disease, or congenital heart disease, relative to pulmonary arteriolar resistance, mean pulmonary wedge pressure and, in one-third of the cases, left atrial pulse contour, led to the following conclusions concerning the transmission of the left atrial pressure pulse to the wedged catheter: 1. 1. When both pulmonary arteriolar resistance and mean pulmonary wedge pressure are low, it is hypothesized that transmission mainly via the pulmonary capillaries leads to damped pulmonary wedge pressure curves, while transmission via pulmonary arteriovenous anastomoses results in undamped pulmonary wedge pressure curves. 2. 2. When the left atrial-pulmonary capillary system is distended, as reflected by an elevated mean pulmonary wedge pressure or mean left atrial pressure, transmission is undamped, apparently independently of arteriovenous anastomoses. 3. 3. When pulmonary arteriolar resistance is greatly elevated, transmission is mainly damped, regardless of the level of pulmonary wedge pressure. In all cases where both wedge pressure curves and left atrial curves were obtained, mean pulmonary wedge pressure corresponded closely to mean left atrial pressure. The incidence of confirmatory blood samples in cases of normal hemodynamics and in the various disease states corresponds roughly with the fidelity with which wedge pressure pulse contour reflects left atrial pressure pulse contour. Le dynamica del circulation minor de 63 subjectos human—normal o con rheumatic o congenite morbo cardiac—esseva studiate con le objectivo de elucidar factores que influentia le transmission del pulso de pression sinistroatrial verso le catheter impingite in le arteria pulmonar. Esseva demonstrate que alte resistentias pulmono-arteriolar habeva un effecto amortiente super le pulso transmittite ab le atrio sinistre. Le curva del pulso de pression a catheter impacte reflecte le curva del pulso sinistro-atrial con remarcabile fidelitate providite que il ha distension del capillares pulmonar e basse resistentia pulmonoarteriolar. Le variabilitate del curvas de pression a catheter impacte, incontrate in subjectos con basse resistentia pulmono-arteriolar e basse pression median a catheter impacte, es attribuibile a anastomoses arterio-venose pulmonar.