The pressure wire as a diagnostic tool in patients with congenital cardiac disease

Abstract

The pressure wire has emerged as a useful tool to assess the clinical severity of moderate coronary artery lesions. We report a novel use of the pressure wire in adult patients with complex congenital cardiac disease in whom it was used in assessing pressures beyond the stenosis in the distal pulmonary artery, aorto-pulmonary collaterals, and across prosthetic tricuspid valves, where conventional catheters were unable to reach. We used this in three of our patients for assessment of pulmonary artery pressures and in two patients for assessment of pressures across a prosthetic St Jude® valve. Out of the three patients referred for assessment, only two had significantly raised distal pulmonary pressures enabling them to receive appropriate therapy. Out of the two patients with a prosthetic tricuspid valve, only one required surgery based on this assessment. We describe a novel use of the pressure wire in the functional assessment of adults with congenital cardiac disease in whom conventional catheter techniques may not be able to provide adequate data. It can be a guide to provide appropriate therapy and avoid unnecessary interventions in this patient group.

Use of the pressure wire method for measuring pulmonary arterial pressures in patients with pulmonary atresia

“…Everett et al 11 used the pressure wire to reach the pulmonary artery in 11 patients, but always through the linear conduct of a modified surgical systemic–pulmonary shunt. Hamid et al 12 described its use in three adult patients with pulmonary atresia where it was not possible to advance the conventional catheters through the collateral vessels into the pulmonary artery. Zampi et al 13 evaluated the effectiveness of pulmonary artery banding, intra-operatively, during the stage I of the Norwood surgical procedure in eight patients.…”

Stenting an aortopulmonary conduit with peripheral cardiopulmonary bypass support

“…PWA is almost exclusively employed in determining the functional significance of coronary lesions of intermediate grade in the form of fractional flow reserve . In congenital heart disease, PWA has been described as a diagnostic tool for assessing pressures in distal PAs and across AP collaterals . Such interrogation of a surgically created AP conduit has not been described previously in the literature.…”

Invasive hemodynamic evaluation in patients with mechanical aortic valves

“…Furthermore, they showed that the calculated aortic valve area with the 0.014 inch pressure wire across the aortic valve did not differ from the calculated area obtained when the LV pressure was measured via the transseptal mitral valve approach . Recently, employment of the 0.014 inch pressure wire has been reported in the evaluation of a Bjork‐Shiley valve in the aortic position and in the hemodynamic evaluation of several congenital anomalies . However, since these initial reports there have not been additional publications describing the safety and detailed technical aspects of this novel approach.…”