ABSTRACT
OBJECTIVES: 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.
Subject(s)
Blood Pressure , Cardiac Catheterization , Heart Defects, Congenital/complications , Pulmonary Artery/physiopathology , Adolescent , Analysis of Variance , Anesthesia, General/adverse effects , Antihypertensive Agents , Cardiac Catheterization/adverse effects , Child , Child, Preschool , Familial Primary Pulmonary Hypertension , Heart Defects, Congenital/physiopathology , Humans , Hypertension, Pulmonary/diagnosis , Hypertension, Pulmonary/etiology , Hypertension, Pulmonary/physiopathology , Infant , Linear Models , Logistic Models , Predictive Value of Tests , Prospective Studies , Registries , Risk Assessment , Risk Factors , Severity of Illness Index , Treatment Outcome , United States , Vasodilator AgentsABSTRACT
Coronary sinus (CS) ostial obstruction decompressing through a left superior vena cava is a rare finding and presents unique risks to patients requiring a Glenn anastomosis for single-ventricle palliation. Preoperative diagnosis is imperative in order to avoid inadvertent ligation or coil occlusion. We report three cases with single-ventricle physiology and CS obstruction identified at cardiac catheterization. Balloon occlusion angiography proved valuable in making the diagnosis.
Subject(s)
Heart Bypass, Right/adverse effects , Heart Defects, Congenital/therapy , Brachiocephalic Veins/diagnostic imaging , Cardiac Catheterization , Catheterization , Female , Humans , Infant , Male , Radiography , Vena Cava, SuperiorABSTRACT
Patients with complex congenital heart disease may have pulmonary artery stenoses that are either congenital or associated with scarring following surgical procedures. This study evaluates cutting balloon angioplasty for small-vessel pulmonary artery stenoses resistant to standard balloon angioplasty. Between October 1998 and December 1999, patients were enrolled in an FDA-approved compassionate-use protocol. During four catheterizations, there were seven lesions found resistant to standard balloon angioplasty (mean lesion diameter was unchanged: 1.8 mm +/- 0.8 mm to 1.9 +/- 0.8 mm). A cutting balloon was inflated twice in each of these lesions. Standard balloon angioplasty was then repeated. Final mean lesion diameter was increased significantly (1.9 mm +/- 0.8 mm to 3.8 +/- 1.3 mm; P Subject(s)
Angioplasty, Balloon/methods
, Heart Defects, Congenital/pathology
, Pulmonary Artery/pathology
, Cardiac Catheterization
, Child
, Child, Preschool
, Constriction, Pathologic
, Humans
