| Assessment of pulmonary hypertension in the pediatric catheterization laboratory: current insights from the Magic registry. | |
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MedLine Citation:
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PMID: 20549685 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Kevin D Hill; D Scott Lim; Allen D Everett; D Dunbar Ivy; J Donald Moore |
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Publication Detail:
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Type: Journal Article; Multicenter Study |
Journal Detail:
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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:
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Created Date: 2010-11-24 Completed Date: 2011-03-10 Revised Date: 2011-11-18 |
Medline Journal Info:
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Nlm Unique ID: 100884139 Medline TA: Catheter Cardiovasc Interv Country: United States |
Other Details:
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Languages: eng Pagination: 865-73 Citation Subset: IM |
Copyright Information:
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Copyright © 2010 Wiley-Liss, Inc. |
Affiliation:
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Division of Pediatric Cardiology, Duke University Medical Center, Durham, North Carolina 27710, USA. kevin.hill@duke.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Analysis of Variance Anesthesia, General / adverse effects Antihypertensive Agents / diagnostic use Blood Pressure* Child Child, Preschool Heart Catheterization* / adverse effects 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:
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P50 HL084923-04/HL/NHLBI NIH HHS |
| Chemical | |
Reg. No./Substance:
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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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