Pulmonary hypertension right heart catheterization

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assistant Editor(s)-in-Chief: Ralph Matar

Right heart Catheterization for pulmonary hypertension:

Cardiac catheterization is still the gold standard for diagnosing, assesing severity, and determining prognosis and response to therapy in pulmonary hypertension.

Right heart catheterization allows for determination of:

1-Presence or absence of pulmonary hypertension, define the underlying etiology, and determine the prognosis.

2- Prognostic markers such as right atrial pressure, cardiac output, and mean pulmonary artery pressure.

3- Pulmonary venous pressures by measuring pulmonary capillary wedge pressure (PCWP). Pulmonary arterial hypertension (PAH) is defined by a PCWP of 15 mmHg or less knowing that the normal PCWP or left ventricular end diastolic pressure (LVEDP) is less than 8 mmHg.

• Fick’s method is reliable in patients with PAH for the measurement of cardiac output:

• Since end-expiratory intrathoracic pressure most closely correlates with atmospheric pressure, it is important that all right ventricular, pulmonary artery, pulmonary wedge, and left ventricular pressures be measured at end-expiration

• This procedure has been shown to be safe, with no deaths reported in the NIH registry study. In addition, a recent study reported a procedure-related mortality of 0.055%.

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