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Treatment with USCDT using a shorter delivery duration and lower-dose tPA was associated with improved right ventricular function and reduced clot burden compared with baseline. The major bleeding rate was low, but 1 intracranial hemorrhage event due to tPA delivered by USCDT did occur.

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Background Determining the cause for pulmonary hypertension (PH) is difficult in many patients. Pulmonary arterial hypertension (PAH) is differentiated from pulmonary venous hypertension (PVH) by a wedge pressure (PWP) >15 mmHg in PVH. Patients undergoing RHC for evaluation of PH may be dehydrated and have reduced intravascular volume, potentially leading to a falsely low measurement of PWP and an erroneous diagnosis of PAH. We hypothesized that a fluid challenge during RHC would identify occult pulmonary venous hypertension (OPVH). Methods and Results We reviewed the results of patients undergoing fluid challenge in our PH database from 2004-2011. Baseline hemodynamics were obtained and repeated following infusion of 0.5 liters of normal saline over 5-10 minutes. Patients were categorized as OPVH if PWP increased to >15 mm Hg after fluid challenge. Baseline hemodynamics in 207 patients met criteria for PAH. Following fluid challenge, 46 patients (22.2%) developed a PWP >15 mm Hg and were re-classified as OPVH. OPVH patients had a greater increase in PWP compared to PAH patients, p<0.001, and their demographics and comorbid illnesses were similar to PVH patients. There were no adverse events related to fluid challenge. Conclusions Fluid challenge at the time of RHC is easily performed, safe, and identifies a large group of patients diagnosed initially with PAH, but for whom OPVH contributes to PH. These results have implications for therapeutic trials in PAH and support the routine use of fluid challenge during RHC in patients with risk factors for PVH.