Measurement of extravascular lung water in infants and children after cardiac surgery.

Extravascular lung water (EVLW) was measured in 17 patients with congenital heart disease by the cold-green-dye, double indicator-dilution technique. In 5 control patients, EVLW was 4.7 +/- 0.5 ml/kg (111 +/- 13 ml/m2) (mean +/- standard deviation). Twelve patients were studied immediately after correction of their heart defects. In 6 patients with normal or decreased pulmonary blood flow preoperatively (Group I), EVLW was 6.2 +/- 1.9 ml/kg (122 +/- 46 ml/m2). This value is not significantly different from that of the control patients. In 6 patients with increased pulmonary blood flow and congestive heart failure preoperatively (Group II), EVLW was 15.7 +/- 3.8 ml/kg (270 +/- 60 ml/m2), which is significantly different from both control and Group I patients (p less than 0.01). There was no correlation of EVLW with pre- or postoperative left atrial pressure, length of cardiopulmonary bypass or deep hypothermic circulatory arrest, postoperative serum protein, albumin, hematocrit or cardiac index. Thus, EVLW in the immediate postoperative period is determined by preoperative pathophysiologic characteristics rather than by intraoperative management, and patients with congestive heart failure resulting from left-to-right shunts have increased EVLW despite normal left atrial pressures.