Conijn M, Dekkers T H P M, Molenschot M M, Breur J M P, Slieker M G, Haas F, Krings G J
Department of Pediatric Cardiology, Wilhelmina Children's Hospital, Utrecht, the Netherlands.
Int J Cardiol Congenit Heart Dis. 2021 Dec 15;7:100306. doi: 10.1016/j.ijcchd.2021.100306. eCollection 2022 Mar.
Pulmonary artery stenosis (PAS) is common in congenital heart disease (CHD). The indication for treatment of PAS is primarily based on invasively measured pressure gradients. Anesthetics used during cardiac catheterization cause systemic and pulmonary hypotension. We hypothesize that this leads to underestimation of right ventricular (RV) pressure load and under treatment of PAS. The aim of this study is to describe the use of epinephrine to unmask RV pressure load in patients with PAS.
All cardiac catheterizations in which epinephrine was administered to evaluate RV load were included. There was an indication for treatment in case of a right to left ventricular (RV:LV) pressure ratio >0.6. The indication for treatment before and after epinephrine was evaluated to determine its role in clinical decision making.
A total of 74 procedures were included. In all procedures the invasively measured LV pressure was below the awake blood pressure. At baseline, 33 patients had a RV:LV ratio >0.6. In 41 patients the baseline RV:LV ratio was <0.6. After epinephrine bolus, the LV pressure was raised up to the awake blood pressure. In 19 of the 41 patients without baseline indication, this resulted in a RV:LV ratio >0.6 thereby revealing the indication for treatment. No epinephrine related complications were registered.
The hypotensive properties of anesthetics during cardiac catheterization may lead to underestimation of RV pressure load. Invasive pressure measurements should be performed under conditions similar to awake conditions. Epinephrine provocation prevented under treatment in 25% of our patients.
肺动脉狭窄（PAS）在先天性心脏病（CHD）中很常见。PAS的治疗指征主要基于有创测量的压力梯度。心脏导管插入术期间使用的麻醉剂会导致全身和肺部低血压。我们假设这会导致右心室（RV）压力负荷被低估以及PAS治疗不足。本研究的目的是描述使用肾上腺素来揭示PAS患者的RV压力负荷。
纳入所有使用肾上腺素来评估RV负荷的心脏导管插入术。如果右心室与左心室（RV:LV）压力比>0.6，则有治疗指征。评估肾上腺素使用前后的治疗指征，以确定其在临床决策中的作用。
共纳入74例手术。在所有手术中，有创测量的LV压力低于清醒时的血压。基线时，33例患者的RV:LV比>0.6。41例患者的基线RV:LV比<0.6。静脉推注肾上腺素后，LV压力升高至清醒时的血压。在41例无基线治疗指征的患者中，有19例因此导致RV:LV比>0.6，从而揭示了治疗指征。未记录到与肾上腺素相关的并发症。
心脏导管插入术期间麻醉剂的降压特性可能导致RV压力负荷被低估。有创压力测量应在类似于清醒状态的条件下进行。肾上腺素激发试验避免了25%的患者治疗不足。
