1 Cardiac Catheterization is Cardiac Catheterization is Unnecessary in the Evaluation of Unnecessary in the Evaluation of Patients with Pulmonary Patients with Pulmonary Hypertension: Hypertension: CON CON Dunbar Ivy, MD Dunbar Ivy, MD The Children The Children’ s Hospital Heart Institute s Hospital Heart Institute 2 Diagnostic Evaluation: Right Heart Cardiac Catheterization ‘Gold Standard’ • Establish diagnosis • Ascertain etiology • Evaluate vasoreactivity • Establish severity & prognosis • Guide treatment McGoon M, Gutterman D, Steen V, et al. Chest 2004;126;14S-34S
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Cardiac Catheterization is Unnecessary in the … Catheterization is Unnecessary in the Evaluation of Patients with Pulmonary Hypertension: CON ... Right Heart Cardiac Catheterization
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Cardiac Catheterization is Cardiac Catheterization is Unnecessary in the Evaluation of Unnecessary in the Evaluation of
Patients with Pulmonary Patients with Pulmonary Hypertension:Hypertension:
•• Sustained elevation of mean pulmonary Sustained elevation of mean pulmonary arterial pressure to > 25 mm Hg, with a arterial pressure to > 25 mm Hg, with a mean pulmonary capillary and left atrial mean pulmonary capillary and left atrial pressure < 15 mm Hg at rest pressure < 15 mm Hg at rest
–– Pulmonary Vascular resistance > 3 Units Pulmonary Vascular resistance > 3 Units X mX m22
Simonneau G, et al. J Am Coll Cardiol 2009;54:S43-S54
Echo Doppler Estimate of PA pressure
Limitations of Doppler Estimate of PA Systolic Pressure
• Requires a good acoustic window
• Requires a good and properly aligned Doppler signal
• Tricuspid regurgitation has to be present
• Can be affected by incorrect assumption of right atrial pressure
•• Acute response Acute response -- ClassicClassic-- Decrease in mPAP of at least 20% Decrease in mPAP of at least 20% -- with the PVR decreasing with the PVR decreasing 20%20%-- with no change or an increase inwith no change or an increase incardiac outputcardiac output
••Acute response Acute response --RevisedRevised-- Decrease in mPAP of at least 10 mmHg Decrease in mPAP of at least 10 mmHg -- with the mPAP decreasing with the mPAP decreasing ≤≤ 40 mmHg 40 mmHg -- with a normal or high cardiac outputwith a normal or high cardiac output