Cardiac Catheterization in Children with Pulmonary Hypertensive Vascular Disease

Abstract

The risks associated with cardiac catheterization in children with pulmonary hypertension (PH) are increased compared with adults. We reviewed retrospectively all clinical data in children with PH [mean pulmonary artery pressure (mean PAp) ≥25 mmHg and pulmonary vascular resistance index (PVRI) ≥3 Wood units m(2)] undergoing cardiac catheterization between 2009 and 2014. Our strategy included a team approach, minimal catheter manipulation and sildenafil administration prior to extubation. Adverse events occurring within 48 h were noted. Seventy-five patients (36 males), median age 4 years (0.3-17) and median weight 14.6 kg (2.6-77 kg), underwent 97 cardiac catheterizations. Diagnoses included idiopathic or heritable pulmonary arterial hypertension (PAH) (29 %), PAH associated with congenital heart disease (52 %), left heart disease (5 %) and lung disease (14 %). Mean PAp was 43 ± 19 mmHg; mean PVRI was 9.7 ± 6 Wood units m(2). There were no deaths or serious arrhythmias. No patient required cardiac massage. Three patients who suffered adverse events had suprasystemic PAp (3/3), heritable PAH (2/3), decreased right ventricular function (3/3), and pulmonary artery capacitance index <1 ml/mmHg/m(2) (3/3) and were treatment naïve (3/3). No patient undergoing follow-up cardiac catheterization suffered a complication. In 45 % of cases, the data acquired from the follow-up cardiac catheterization resulted in an alteration of therapy. Three percent of children with PH undergoing cardiac catheterization suffered adverse events. However, there were no intra or post procedural deaths and no one required cardiac massage or cardioversion. Follow-up cardiac catheterization in patients receiving pulmonary hypertensive targeted therapy is safe and provides useful information.

Pulmonary Hypertension

“…However, the proper timing of cardiac catheterization is often less clear, in part because the risks increase in patients with acute disease. In fact, a recent study found that the risks of cardiac catheterization are higher in pediatric patients with PH compared to adults, but that it can be performed safely in these patients when undertaken with a programmatic approach (10). …”

Prediction of early-onset atrial tachyarrhythmia after successful trans-catheter device closure of atrial septal defect

“…[20–22] The occurrence of AF in patients with uncorrected ASD is estimated to be 20%, and the prevalence of atrial arrhythmia increases with age and mean pulmonary arterial pressure. [7,17,20,21] Long-standing volume overload due to left-to-right shunts causes enlargement of the right atrium. Even many years after correction, this may result in conduction disturbances in the atrial myocardium.…”

“…[17] Trans-catheter closure was performed by 2 pediatricians who specialized in interventional procedures. All procedures were performed with the Amplatzer Septal Occluder (ASO, AGA Medical, Golden Valley, MN).…”

Reply

“…In the series from Bobhate, Zuckerman, and Beghetti(2–4) the 95% confidence intervals for observed risk of mortality are 0–3.7%, 0.2–1.0%, and 0.2–1.3%. The standardized risk of composite outcome in our study was slightly higher (3.3%, 95% CI: 1.9–5.5%).…”