Document Detail


Assessment of pulmonary hypertension in the pediatric catheterization laboratory: current insights from the Magic registry.
MedLine Citation:
PMID:  20549685     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To assess protocols, demographics, and hemodynamics in pediatric patients undergoing catheterization for pulmonary hypertension (PH). Background: Pediatric specific data is limited on PH.
METHODS: Review of the Mid-Atlantic Group of Interventional Cardiology (MAGIC) collaboration PH registry dataset.
RESULTS: Between November 2003 and October 2008, seven institutions submitted data from 177 initial catheterizations in pediatric patients with suspected PH. Pulmonary arterial hypertension associated with congenital heart disease (APAH-CHD) (n = 61, 34%) was more common than idiopathic PAH (IPAH) (n = 36, 20%). IPAH patients were older with higher mean pulmonary arterial pressures (mPAP) (P < 0.01). Oxygen lowered mPAP in patients with IPAH (P < 0.01) and associated PAH not related to congenital heart disease (APAH-non CHD) (P < 0.01). A synergistic effect was seen with inhaled nitric oxide (iNO) (P < 0.01). Overall 9/30 (29%) patients with IPAH and 8/48 (16%) patients with APAH-non CHD were reactive to vasodilator testing. Oxygen lowered pulmonary vascular resistance index (PVRI) in patients with APAH-CHD (P < 0.01). There was no additive effect with iNO but a subset of patients required iNO to lower PVRI below 5 WU·m(2). General anesthesia (GA) lowered systemic arterial pressure (P < 0.01) with no difference between GA and procedural sedation on mPAP or PVRI. Adverse events were rare (n = 7) with no procedural deaths.
CONCLUSIONS: Pediatric patients with PH demonstrate a higher incidence of APAH-CHD and neonatal specific disorders compared to adults. Pediatric PH patients may demonstrate baseline mPAP < 40 mm Hg but > 50% systemic illustrating the difficulty in applying adult criteria to children with PH. Catheterization in children with PH is relatively safe.
Authors:
Kevin D Hill; D Scott Lim; Allen D Everett; D Dunbar Ivy; J Donald Moore
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Publication Detail:
Type:  Journal Article; Multicenter Study    
Journal Detail:
Title:  Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions     Volume:  76     ISSN:  1522-726X     ISO Abbreviation:  Catheter Cardiovasc Interv     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-11-24     Completed Date:  2011-03-10     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  100884139     Medline TA:  Catheter Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  865-73     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 Wiley-Liss, Inc.
Affiliation:
Division of Pediatric Cardiology, Duke University Medical Center, Durham, North Carolina 27710, USA. kevin.hill@duke.edu
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Analysis of Variance
Anesthesia, General / adverse effects
Antihypertensive Agents / diagnostic use
Blood Pressure*
Cardiac Catheterization* / adverse effects
Child
Child, Preschool
Heart Defects, Congenital / complications*,  physiopathology
Humans
Hypertension, Pulmonary / diagnosis,  etiology,  physiopathology
Infant
Linear Models
Logistic Models
Predictive Value of Tests
Prospective Studies
Pulmonary Artery / physiopathology*
Registries
Risk Assessment
Risk Factors
Severity of Illness Index
Treatment Outcome
United States
Vasodilator Agents / diagnostic use
Grant Support
ID/Acronym/Agency:
P50 HL084923-04/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Antihypertensive Agents; 0/Vasodilator Agents
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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