Gartenberg Ari J, O'Byrne Michael L, Leeth Ella B, Tang Jessica, Gupta Mudit, Rome Jonathan J, Callahan Ryan
Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
J Soc Cardiovasc Angiogr Interv. 2024 Feb 28;3(4):101350. doi: 10.1016/j.jscai.2024.101350. eCollection 2024 Apr.
Pulmonary artery wedge pressure (PAWP) can underestimate directly measured pulmonary vein pressure (PVP) as demonstrated in animal studies and human case reports. This concept has not been validated in a larger cohort of pediatric patients with pulmonary vein stenosis (PVS).
Pediatric patients who underwent cardiac catheterization for PVS at a single center from January 1, 2018, to March 31, 2023, were retrospectively reviewed. Mismatch between the PAWP and directly measured PVP or LA pressure was defined as >3 mm Hg. Preintervention angiography was reviewed and percent stenosis calculated.
Twenty-six patients met inclusion criteria; 51 lower pulmonary veins (34 left, 17 right) from 42 catheterizations were evaluated. Significant PVS (≥30% stenosis) was seen in 38/51 (75%) veins, and 9/51 (18%) veins had no angiographic narrowing (0% stenosis). PAWP-PVP mismatch occurred in 37/51 (73%) veins with a median difference of 8 mm Hg (IQR, 6-12). Of these, PAWP was equal to LA pressure in 26 instances, all of which had significant PVS (median % stenosis 54 [IQR, 45-60]). Six of the cases with PAWP-PVP mismatch, PVS (range, 41%-70% stenosis), and no PAWP-LA mismatch reported both a proximal and distal segmental PAWP. In all 6 instances, there was no distal PAWP-PVP mismatch (median difference 1 mm Hg [range, 0-3]).
In this single-center study of pediatric patients with PVS, PAWP significantly underestimated directly measured PVP in lower pulmonary veins. Balloon wedge or end hole catheter position in a distal lobar segment may more accurately estimate the PVP.
如动物研究和人类病例报告所示，肺动脉楔压（PAWP）可能会低估直接测量的肺静脉压（PVP）。这一概念尚未在更大规模的小儿肺静脉狭窄（PVS）患者队列中得到验证。
对2018年1月1日至2023年3月31日在单一中心因PVS接受心导管检查的小儿患者进行回顾性分析。PAWP与直接测量的PVP或左心房压力之间的差值>3 mmHg被定义为不匹配。回顾干预前的血管造影并计算狭窄百分比。
26例患者符合纳入标准；对42次心导管检查中的51条下肺静脉（34条左侧，17条右侧）进行了评估。38/51（75%）条静脉存在显著的PVS（≥30%狭窄），9/51（18%）条静脉无血管造影狭窄（0%狭窄）。37/51（73%）条静脉出现PAWP - PVP不匹配，中位数差值为8 mmHg（四分位间距，6 - 12）。其中，26例PAWP等于左心房压力，所有这些病例均有显著的PVS（狭窄百分比中位数为54 [四分位间距，45 - 60]）。6例PAWP - PVP不匹配、PVS（狭窄范围41% - 70%）且无PAWP - 左心房不匹配的病例报告了近端和远端节段性PAWP。在所有6例中，远端PAWP - PVP无不匹配（中位数差值1 mmHg [范围，0 - 3]）。
在这项针对小儿PVS患者的单中心研究中，PAWP显著低估了下肺静脉直接测量的PVP。球囊楔入或端孔导管置于远端肺叶节段可能更准确地估计PVP。
