Assessment of pulmonary hypertension in the pediatric catheterization laboratory: current insights from the Magic registry.
OBJECTIVE
To assess protocols, demographics, and hemodynamics in pediatric patients undergoing catheterization for pulmonary hypertension (PH).


BACKGROUND
Pediatric specific data is limited on PH.


METHODS
Review of the Mid-Atlantic Group of Interventional Cardiology (MAGIC) collaboration PH registry dataset.


RESULTS
Between November 2003 and October 2008, seven institutions submitted data from 177 initial catheterizations in pediatric patients with suspected PH. Pulmonary arterial hypertension associated with congenital heart disease (APAH-CHD) (n = 61, 34%) was more common than idiopathic PAH (IPAH) (n = 36, 20%). IPAH patients were older with higher mean pulmonary arterial pressures (mPAP) (P < 0.01). Oxygen lowered mPAP in patients with IPAH (P < 0.01) and associated PAH not related to congenital heart disease (APAH-non CHD) (P < 0.01). A synergistic effect was seen with inhaled nitric oxide (iNO) (P < 0.01). Overall 9/30 (29%) patients with IPAH and 8/48 (16%) patients with APAH-non CHD were reactive to vasodilator testing. Oxygen lowered pulmonary vascular resistance index (PVRI) in patients with APAH-CHD (P < 0.01). There was no additive effect with iNO but a subset of patients required iNO to lower PVRI below 5 WU·m(2). General anesthesia (GA) lowered systemic arterial pressure (P < 0.01) with no difference between GA and procedural sedation on mPAP or PVRI. Adverse events were rare (n = 7) with no procedural deaths.


CONCLUSIONS
Pediatric patients with PH demonstrate a higher incidence of APAH-CHD and neonatal specific disorders compared to adults. Pediatric PH patients may demonstrate baseline mPAP < 40 mm Hg but > 50% systemic illustrating the difficulty in applying adult criteria to children with PH. Catheterization in children with PH is relatively safe.
Hill
Kevin D
KD
Division of Pediatric Cardiology, Duke University Medical Center, Durham, North Carolina 27710, USA. kevin.hill@duke.edu
Lim
D Scott
DS
Everett
Allen D
AD
Ivy
D Dunbar
DD
Moore
J Donald
JD
D000293:Adolescent; D000704:Analysis of Variance; D000768:Anesthesia, General / Q000009:adverse effects; D000959:Antihypertensive Agents; D001794:Blood Pressure; D006328:Cardiac Catheterization / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D065627:Familial Primary Pulmonary Hypertension; D006330:Heart Defects, Congenital / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D007223:Infant; D016014:Linear Models; D016015:Logistic Models; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000503:physiopathology*; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014481:United States; D014665:Vasodilator Agents
D000959:Antihypertensive Agents; D014665:Vasodilator Agents