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 m2] 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 m2. 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/m2 (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.
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Adatia I, Perry S, Landzberg M, Moore P, Thompson JE, Wessel DL (1995) Inhaled nitric oxide and hemodynamic evaluation of patients with pulmonary hypertension before transplantation. J Am Coll Cardiol 25:1656–1664
Adatia I, Haworth SG, Wegner M, Barst RJ, Ivy D, Stenmark KR, Karkowsky A, Rosenzweig E, Aguilar C (2013) Clinical trials in neonates and children: report of the pulmonary hypertension academic research consortium pediatric advisory committee. Pulm Circ 3:252–266
Beghetti M, Berger RM, Schulze-Neick I, Day RW, Pulido T, Feinstein J, Barst RJ, Humpl T, Investigators TR (2013) Diagnostic evaluation of paediatric pulmonary hypertension in current clinical practice. Eur Respir J 42:689–700
Carmosino MJ, Friesen RH, Doran A, Ivy DD (2007) Perioperative complications in children with pulmonary hypertension undergoing noncardiac surgery or cardiac catheterization. Anesth Analg 104:521–527
Chida A, Shintani M, Yagi H, Fujiwara M, Kojima Y, Sato H, Imamura S, Yokozawa M, Onodera N, Horigome H, Kobayashi T, Hatai Y, Nakayama T, Fukushima H, Nishiyama M, Doi S, Ono Y, Yasukouchi S, Ichida F, Fujimoto K, Ohtsuki S, Teshima H, Kawano T, Nomura Y, Gu H, Ishiwata T, Furutani Y, Inai K, Saji T, Matsuoka R, Nonoyama S, Nakanishi T (2012) Outcomes of childhood pulmonary arterial hypertension in BMPR2 and ALK1 mutation carriers. Am J Cardiol 110:586–593
del Cerro MJ, Abman S, Diaz G, Freudenthal AH, Freudenthal F, Harikrishnan S, Haworth SG, Ivy D, Lopes AA, Raj JU, Sandoval J, Stenmark K, Adatia I (2011) A consensus approach to the classification of pediatric pulmonary hypertensive vascular disease: report from the PVRI pediatric taskforce, Panama 2011. Pulm Circ 1:286–298
Douwes JM, Roofthooft MT, Bartelds B, Talsma MD, Hillege HL, Berger RM (2013) Pulsatile haemodynamic parameters are predictors of survival in paediatric pulmonary arterial hypertension. Int J Cardiol 168:1370–1377
Guo L, Cui Y, Pharis S, Walsh M, Atallah J, Tan MW, Rutledge J, Coe JY, Adatia I (2014) Measurement of oxygen consumption in children undergoing cardiac catheterization: comparison between mass spectrometry and the breath-by-breath method. Pediatr Cardiol 35:798–802
Hill KD, Lim DS, Everett AD, Ivy DD, Moore JD (2010) Assessment of pulmonary hypertension in the pediatric catheterization laboratory: current insights from the Magic registry. Catheter Cardiovasc Interv 76:865–873
Ivy DD, Abman SH, Barst RJ, Berger RM, Bonnet D, Fleming TR, Haworth SG, Raj JU, Rosenzweig EB, Schulze Neick I, Steinhorn RH, Beghetti M (2013) Pediatric pulmonary hypertension. J Am Coll Cardiol 62:D117–D126
Kulik T, Mullen M, Adatia I (2009) Pulmonary arterial hypertension associated with congenital heart disease. Prog Pediatr Cardiol 27:25–33
Lin CH, Hegde S, Marshall AC, Porras D, Gauvreau K, Balzer DT, Beekman RH 3rd, Torres A, Vincent JA, Moore JW, Holzer R, Armsby L, Bergersen L (2014) Incidence and management of life-threatening adverse events during cardiac catheterization for congenital heart disease. Pediatr Cardiol 35:140–148
Moledina S, Hislop AA, Foster H, Schulze-Neick I, Haworth SG (2010) Childhood idiopathic pulmonary arterial hypertension: a national cohort study. Heart (British Cardiac Society) 96:1401–1406
Nafiu OO, Voepel-Lewis T, Morris M, Chimbira WT, Malviya S, Reynolds PI, Tremper KK (2009) How do pediatric anesthesiologists define intraoperative hypotension? Paediatr Anaesth 19:1048–1053
Palmer SM, Robinson LJ, Wang A, Gossage JR, Bashore T, Tapson VF (1998) Massive pulmonary edema after prostacyclin infusion in a patient with pulmonary veno-occlusive disease. Chest 113:237–240
Sajan I, Manlhiot C, Reyes J, McCrindle BW, Humpl T, Friedberg MK (2011) Pulmonary arterial capacitance in children with idiopathic pulmonary arterial hypertension and pulmonary arterial hypertension associated with congenital heart disease: relation to pulmonary vascular resistance, exercise capacity, and survival. Am Heart J 162:562–568
Sitbon O, Humbert M, Jais X, Ioos V, Hamid AM, Provencher S, Garcia G, Parent F, Herve P, Simonneau G (2005) Long-term response to calcium channel blockers in idiopathic pulmonary arterial hypertension. Circulation 111:3105–3111
Sury MR, William Broadhead M (2009) Hypotension during anesthesia before surgery. Paediatr Anaesth 19:1037–1040
Taylor CJ, Derrick G, McEwan A, Haworth SG, Sury MR (2007) Risk of cardiac catheterization under anaesthesia in children with pulmonary hypertension. Br J Anaesth 98:657–661
van Loon RL, Roofthooft MT, Hillege HL, ten Harkel ADJ, van Osch-Gevers M, Delhaas T, Kapusta L, Strengers JL, Rammeloo L, Clur SAB, Mulder BJ, Berger RMF (2011) Pediatric pulmonary hypertension in the Netherlands. Epidemiology and characterization during the period 1991 to 2005. Circulation 124:1755–1764
Williams GD, Philip BM, Chu LF, Boltz MG, Kamra K, Terwey H, Hammer GB, Perry SB, Feinstein JA, Ramamoorthy C (2007) Ketamine does not increase pulmonary vascular resistance in children with pulmonary hypertension undergoing sevoflurane anesthesia and spontaneous ventilation. Anesth Analg 105:1578–1584
Williams GD, Maan H, Ramamoorthy C, Kamra K, Bratton SL, Bair E, Kuan CC, Hammer GB, Feinstein JA (2010) Perioperative complications in children with pulmonary hypertension undergoing general anesthesia with ketamine. Paediatr Anaesth 20:28–37
Acknowledgments
The study was funded by a grant from the Women and Children’s Health Research Institute through the Stollery Children’s Hospital Foundation. Dr Long Guo was supported by a Deloitte Foundation/Stollery Children’s Hospital Fellowship Grant.
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Bobhate, P., Guo, L., Jain, S. et al. Cardiac Catheterization in Children with Pulmonary Hypertensive Vascular Disease. Pediatr Cardiol 36, 873–879 (2015). https://doi.org/10.1007/s00246-015-1100-1
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DOI: https://doi.org/10.1007/s00246-015-1100-1