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Assessment of pulmonary hypertension in the pediatric catheterization laboratory: current insights from the Magic registry.

Publication ,  Journal Article
Hill, KD; Lim, DS; Everett, AD; Ivy, DD; Moore, JD
Published in: Catheter Cardiovasc Interv
November 15, 2010

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.

Duke Scholars

Published In

Catheter Cardiovasc Interv

DOI

EISSN

1522-726X

Publication Date

November 15, 2010

Volume

76

Issue

6

Start / End Page

865 / 873

Location

United States

Related Subject Headings

  • Vasodilator Agents
  • United States
  • Treatment Outcome
  • Severity of Illness Index
  • Risk Factors
  • Risk Assessment
  • Registries
  • Pulmonary Artery
  • Prospective Studies
  • Predictive Value of Tests
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Hill, K. D., Lim, D. S., Everett, A. D., Ivy, D. D., & Moore, J. D. (2010). Assessment of pulmonary hypertension in the pediatric catheterization laboratory: current insights from the Magic registry. Catheter Cardiovasc Interv, 76(6), 865–873. https://doi.org/10.1002/ccd.22693
Hill, Kevin D., D Scott Lim, Allen D. Everett, D Dunbar Ivy, and J Donald Moore. “Assessment of pulmonary hypertension in the pediatric catheterization laboratory: current insights from the Magic registry.Catheter Cardiovasc Interv 76, no. 6 (November 15, 2010): 865–73. https://doi.org/10.1002/ccd.22693.
Hill KD, Lim DS, Everett AD, Ivy DD, Moore JD. Assessment of pulmonary hypertension in the pediatric catheterization laboratory: current insights from the Magic registry. Catheter Cardiovasc Interv. 2010 Nov 15;76(6):865–73.
Hill, Kevin D., et al. “Assessment of pulmonary hypertension in the pediatric catheterization laboratory: current insights from the Magic registry.Catheter Cardiovasc Interv, vol. 76, no. 6, Nov. 2010, pp. 865–73. Pubmed, doi:10.1002/ccd.22693.
Hill KD, Lim DS, Everett AD, Ivy DD, Moore JD. Assessment of pulmonary hypertension in the pediatric catheterization laboratory: current insights from the Magic registry. Catheter Cardiovasc Interv. 2010 Nov 15;76(6):865–873.
Journal cover image

Published In

Catheter Cardiovasc Interv

DOI

EISSN

1522-726X

Publication Date

November 15, 2010

Volume

76

Issue

6

Start / End Page

865 / 873

Location

United States

Related Subject Headings

  • Vasodilator Agents
  • United States
  • Treatment Outcome
  • Severity of Illness Index
  • Risk Factors
  • Risk Assessment
  • Registries
  • Pulmonary Artery
  • Prospective Studies
  • Predictive Value of Tests