A safe technique to monitor pulmonary artery pressure during and after paediatric cardiac surgery.

Pulmonary hypertensive crises (PHC) are a recognized cause of sudden clinical deterioration and death after the surgical correction of congenital heart disease. In this study, pulmonary artery pressure was monitored in 84 children (at high risk to develop PHC) aged nine days to five years (mean 1.4 years) using monitoring lines inserted percutaneously through the right internal jugular vein (IJV). Success rate of placement of the catheter tip in the pulmonary artery (PA) in the pre-incision period was not high (7%) but all catheter-tips were successfully placed in the PA by the surgeon before right atrial closure prior to separation from cardiopulmonary bypass. Complications related to the technique were transient ventricular/atrial arrhythmias (78.5%) during insertion and slipping or coiling (20%) of the catheter in the right ventricle. Complications relating to the IJV puncture included carotid arterial puncture and pneumothorax. No other complications were encountered. Monitoring lines inserted percutaneously and guided into the pulmonary artery during surgery provide a safe and practical way of monitoring pulmonary artery in infants and children at risk of postoperative pulmonary hypertensive crises.