Bobhate Prashant, Guo Long, Jain Shreepal, Haugen Richard, Coe James Y, Cave Dominic, Rutledge Jennifer, Adatia Ian
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.
Pediatr Cardiol. 2015 Apr;36(4):873-9. doi: 10.1007/s00246-015-1100-1. Epub 2015 Jan 11.
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.
与成人相比，肺动脉高压（PH）患儿进行心导管插入术的风险更高。我们回顾性分析了2009年至2014年间接受心导管插入术的PH患儿[平均肺动脉压（平均PAp）≥25 mmHg且肺血管阻力指数（PVRI）≥3伍德单位/m²]的所有临床资料。我们的策略包括团队协作、尽量减少导管操作以及拔管前给予西地那非。记录48小时内发生的不良事件。75例患者（36例男性），中位年龄4岁（0.3 - 17岁），中位体重14.6 kg（2.6 - 77 kg），接受了97次心导管插入术。诊断包括特发性或遗传性肺动脉高压（PAH）（29%）、与先天性心脏病相关的PAH（52%）、左心疾病（5%）和肺部疾病（14%）。平均PAp为43 ± 19 mmHg；平均PVRI为9.7 ± 6伍德单位/m²。无死亡或严重心律失常发生。无患者需要心脏按压。3例发生不良事件的患者具有体循环高压PAp（3/3）、遗传性PAH（2/3）、右心室功能下降（3/3）、肺动脉容量指数<1 ml/mmHg/m²（3/3）且未接受过治疗（3/3）。接受随访心导管插入术的患者均未发生并发症。在45%的病例中，随访心导管插入术获取的数据导致了治疗方案的改变。3%接受心导管插入术的PH患儿发生了不良事件。然而，术中及术后均无死亡病例，也无人需要心脏按压或心脏复律。接受肺动脉高压靶向治疗的患者进行随访心导管插入术是安全的，并能提供有用信息。
