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
Overview
- In primary pulmonary hypertension the pulmonary artery diastolic pressure is much higher than the pulmonary capillary wedge pressure.
- If the pulmonary hypertension is due to left-sided heart failure, and the pulmonary artery diastolic pressure in the pulmonary capillary wedge pressure will be similar.
- In the cardiac catheterization laboratory, inhaled nitric oxide is administered to determine if the pulmonary vasculature is still reactive or if the obstructionist fixed. It is dangerous to give nifedipine IV as a test because it could lead to a dangerous episode of hypotension.
Right heart Catheterization
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%.