Monitoring of Hemodynamics With Right Heart Catheterization in Children With Pulmonary Arterial Hypertension

Abstract

Background Right heart catheterization (RHC) is a high‐risk procedure in children with pulmonary arterial hypertension without clear guidelines for the indications and targets of invasive reassessment. Our objectives are to define the aims of repeated RHC and evaluate the correlation between noninvasive criteria and hemodynamic parameters. Methods and Results Clinical and hemodynamic characteristics from 71 incident treatment‐naïve children (median age 6.2 years) with pulmonary arterial hypertension who had a baseline and reevaluation RHC were analyzed. Correlations between noninvasive predictors and hemodynamic parameters were tested. Adverse outcomes were defined as death, lung transplantation, or Potts shunt. At baseline, pulmonary vascular resistance index (hazard ratio [HR] 1.07 per 1 WU·m 2 increase [95% CI, 1.02–1.12], P =0.002), stroke volume index (HR 0.95 per 1 L·min −1 ·m −2 increase [95% CI, 0.91–0.99], P =0.012), pulmonary artery compliance index (HR 0.16 per 1 mL·mm Hg −1· m −2 increase [95% CI, 0.051–0.52], P =0.002), and right atrial pressure (HR, 1.31 per 1 mm Hg increase [95% CI, 1.01–1.71], P =0.043) were associated with adverse outcomes. Pulmonary vascular resistance index, pulmonary artery compliance index, and right atrial pressure were still associated with a worse outcome at second RHC. Noninvasive criteria accurately predicted hemodynamic evolution; however, 70% of the patients who had improved based on noninvasive criteria still presented at least 1 “at risk” hemodynamics at second RHC. Conclusions Pulmonary vascular resistance index, pulmonary artery compliance index, and right atrial pressure are solid predictors of adverse outcomes in pediatric pulmonary arterial hypertension and potential therapeutic targets. Noninvasive criteria accurately predict the evolution of hemodynamic parameters, but insufficiently. Repeated RHC are helpful to identify children with persistent higher risk after treatment introduction.

Paediatric pulmonary hypertension due to congenital heart disease in non-cardiac surgery: Anaesthetic implications

“…8,12 Few studies report mPAP (mean pulmonary arterial pressure)/mSAP (mean systemic arterial pressure) ratio >0.75, mRAP (mean right atrial pressure) >10 mmHg, and PVRI >20 WU•m2 affecting prognosis. 8,[15][16][17] Failure to thrive predicts mortality, 9 while unlike adults baseline 6min walk distance has a limited role. 5 Since the treatment relies on risk stratification, the current guidelines utilize certain risk assessment tools as analyzed in retrospective observational studies viz.…”

A single institution anesthetic experience with catheterization of pediatric pulmonary hypertension patients

“…In addition to obtaining direct pressure measurements, catheterization facilitates the determination of cardiac output, vascular resistances, vascular reactivity, and the ability to perform interventional procedures. 1,[6][7][8][9][10][11][12][13][14][15] Despite these advantages, the need for anesthesia or sedation adds an additional layer of complexity to the choice to proceed with cardiac catheterization in pediatric patients. [6][7][8][9] The reported risk of serious adverse events during cardiac catheterization for pediatric pulmonary hypertension (PH) patients is variable, ranging from 2% to 6%.…”

“…However, invasive cardiac catheterization remains the “gold standard” for the diagnosis and management of pediatric pulmonary vascular disease. In addition to obtaining direct pressure measurements, catheterization facilitates the determination of cardiac output, vascular resistances, vascular reactivity, and the ability to perform interventional procedures 1,6–15 …”