Risk Factors for Adverse Events in Children with Pulmonary Hypertension Undergoing Cardiac Catheterization

Autor: Laura A. Downey, Holly Bauser-Heaton, Usama Kanaan, Danish Vaiyani, Christopher J. Petit, Michael Kelleman
Rok vydání: 2021
Předmět:
Heart Defects
Congenital
Male
Cardiac Catheterization
medicine.medical_specialty
Time Factors
Hypertension
Pulmonary
medicine.medical_treatment
Pulmonary Artery
030204 cardiovascular system & hematology
Nitric Oxide
03 medical and health sciences
0302 clinical medicine
Risk Factors
medicine.artery
Internal medicine
medicine
Humans
Anesthesia
Pulmonary Wedge Pressure
Child
Pulmonary wedge pressure
Adverse effect
Retrospective Studies
Cardiac catheterization
business.industry
Hemodynamics
Infant
medicine.disease
Pulmonary hypertension
Heart Arrest
Cardiac surgery
medicine.anatomical_structure
030228 respiratory system
Child
Preschool
Heart failure
Pediatrics
Perinatology and Child Health
Pulmonary artery
Vascular resistance
Cardiology
Female
Vascular Resistance
Cardiology and Cardiovascular Medicine
business
Zdroj: Pediatric Cardiology. 42:736-742
ISSN: 1432-1971
0172-0643
DOI: 10.1007/s00246-020-02535-4
Popis: Pulmonary hypertension (PH) can lead to progressive heart failure with high morbidity and mortality. Cardiac catheterization (CC) is the gold standard for diagnosis and response to vasodilatory medications. The invasive nature of CC and associated anesthesia predispose this patient population to adverse events including death. Catheterization records were queried from 1/1/2011 to 10/31/2016. Patients with PH, defined as pulmonary vascular resistance (PVR) greater than 3 WU m2, pulmonary artery pressure above 20 mmHg, and pulmonary wedge pressure less than or equal to 15 mmHg, who underwent hemodynamic CC were included in this retrospective study. Both patients with and without congenital heart disease were included. There were 198 CC in 191 patients. Adverse events (n = 28, 14.1%) included cardiac arrest, increased respiratory support requiring ICU care, PH crisis, bradycardia/hypotension requiring intervention, and arrhythmias. Odds of an adverse event increased by 22% for every 15-min increase in procedure times (OR 1.22, CI 1.01–1.39, p = 0.002) and were significantly increased for procedures longer than 80 min (OR 3.75, CI 1.56–9.00, p = 0.007) (Fig. 1). Patients with an adverse event had higher mean pulmonary artery pressures while breathing oxygen (43 [35–58] versus 34 [27–44] mmHg, p = 0.017) and oxygen with inhaled nitric oxide (37 [32–56] versus 32 [25–40] mmHg, p = 0.026). Females carried more risk than males (OR 3.88, CI 1.44–10.40, p = 0.007). Younger age, medication regimens, prematurity, and genetic disease did not carry an increased risk. Adverse events are common in pediatric patients with PH undergoing CC. The risk of adverse events correlates with greater procedure times and higher mean pulmonary artery pressure. Minimizing procedure time may improve patient outcomes.
Databáze: OpenAIRE
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