Right Heart Catheterization—Background, Physiological Basics, and Clinical Implications

Abstract

The idea of right heart catheterization (RHC) grew in the milieu of modern thinking about the cardiovascular system, influenced by the experiments of William Harvey, which were inspired by the treatises of Greek philosophers like Aristotle and Gallen, who made significant contributions to the subject. RHC was first discovered in the eighteenth century by William Hale and was subsequently systematically improved by outstanding experiments in the field of physiology, led by Cournand and Dickinson Richards, which finally resulted in the implementation of pulmonary artery catheters (PAC) into clinical practice by Jeremy Swan and William Ganz in the early 1970s. Despite its premature euphoric reception, some further analysis seemed not to share the early enthusiasm as far as the safety and effectiveness issues were concerned. Nonetheless, RHC kept its significant role in the diagnosis, prognostic evaluation, and decision-making of pulmonary hypertension and heart failure patients. Its role in the treatment of end-stage heart failure seems not to be fully understood, although it is promising. PAC-guided optimization of the treatment of patients with ventricular assist devices and its beneficial introduction into clinical practice remains a challenge for the near future.

Characterization of Patients with Pulmonary Arterial Hypertension: Data from the Polish Registry of Pulmonary Hypertension (BNP-PL)

“…For the purpose of the present study, we analyzed the data of newly and previously diagnosed PAH adult (≥18 years old) patients who were under the care of the participating centers between 1 March 2018 and 30 September 2018. The diagnostic algorithm was based on current recommendations [11,[13][14][15][16][17][18][19]. Newly diagnosed patients were those whose diagnosis was established since 1 March 2018 (termed 'incident cases').…”

Proximal Learning for Individualized Treatment Regimes Under Unmeasured Confounding

“…In contrast, our estimated ITRs tend to suggest trauma patients (trauma), and patients diagnosed with coma (cat1 coma, cat2 coma), lung cancer (cat1 lung, cat2 lung) or congestive heart failure (cat1 chf) undergo RHC. Clinically, RHC is of value when the hemodynamic state of a patient is in question or changing rapidly and is thus potentially helpful with patients in critical condition whose hemodynamic states are unstable [Kubiak et al, 2019]. Those findings can be partially supported by Hernandez et al [2019] and Tehrani et al [2019], but require further investigations.…”

Hipertensión pulmonar en cardiopatías congénitas del adulto

“…Se necesita, además, evidencia de enfermedad vascular pulmonar, por lo que debe incluir un aumento de la RVP a un valor mayor o igual a 3 unidades Wood (≥ 3 UW). Esto es necesario para realizar diagnóstico de la hipertensión pulmonar precapilar, independientemente de la etiología, que representa el perfil hemodinámico de la mayoría de los pacientes con HAP por CCA y lo encontraremos a su vez en el grupo 1 de la clasificación clínica de hipertensión pulmonar (12,17) .…”