title: 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.
authors.affiliation: Pediatric Pulmonary Hypertension Service, Pediatric Cardiology and Cardiac Critical Care, Department of Pediatrics and Anaesthesia, Stollery Children's Hospital and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada.
authors.forename: Prashant
authors.initials: P
authors.lastname: Bobhate
authors.forename: Long
authors.initials: L
authors.lastname: Guo
authors.forename: Shreepal
authors.initials: S
authors.lastname: Jain
authors.forename: Richard
authors.initials: R
authors.lastname: Haugen
authors.forename: James Y
authors.initials: JY
authors.lastname: Coe
authors.forename: Dominic
authors.initials: D
authors.lastname: Cave
authors.forename: Jennifer
authors.initials: J
authors.lastname: Rutledge
authors.forename: Ian
authors.initials: I
authors.lastname: Adatia
mesh_terms: D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods*; D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D011651:Pulmonary Artery / Q000503:physiopathology*; D012189:Retrospective Studies; D014655:Vascular Resistance