Cardiac catheterization in children with pulmonary hypertensive vascular disease

Area of Science:

• Pediatric Cardiology
• Pulmonary Hypertension Research
• Interventional Cardiology

Background:

• Cardiac catheterization in pediatric pulmonary hypertension (PH) carries higher risks than in adults.
• Specific risk factors and outcomes in this vulnerable population require careful evaluation.
• Optimizing procedural safety and therapeutic guidance is crucial for managing pediatric PH.

Purpose of the Study:

• To assess the safety and efficacy of cardiac catheterization in children with PH.
• To identify risk factors associated with adverse events during the procedure.
• To evaluate the impact of follow-up cardiac catheterizations on treatment strategies.

Main Methods:

• Retrospective review of clinical data from 75 children with PH undergoing 97 cardiac catheterizations (2009-2014).
• Defined PH as mean pulmonary artery pressure (mean PAp) ≥25 mmHg and pulmonary vascular resistance index (PVRI) ≥3 Wood units m(2).
• Implemented a strategy including a team approach, minimal catheter manipulation, and pre-extubation sildenafil; adverse events within 48 hours were recorded.

Main Results:

• No deaths or serious arrhythmias occurred; no patient required cardiac massage.
• 3% of children experienced adverse events, primarily those with suprasystemic PAp, heritable PH, reduced right ventricular function, low pulmonary artery capacitance, and treatment-naïve status.
• Follow-up cardiac catheterizations were complication-free and led to therapy alterations in 45% of cases.

Conclusions:

• Cardiac catheterization in children with PH can be performed safely with a low rate of serious adverse events.
• Specific patient characteristics predict adverse outcomes, guiding risk stratification.
• Follow-up cardiac catheterization in children with PH receiving targeted therapy is safe and valuable for optimizing treatment.