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; Rim Halaby

Overview

Cardiac catheterization is still the gold standard for diagnosing, assessing the severity, and determining the prognosis and response to therapy in pulmonary hypertension. In the cardiac catheterization laboratory, inhaled nitric oxide is administered to determine if the pulmonary vasculature is still reactive or if the obstruction is fixed. It is dangerous to give nifedipine IV as a test because it could lead to a dangerous episode of hypotension. 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%.

Right Heart Catheterization

<figure-inline>Fick's principal for calculating cardiac output.png</figure-inline>

  • 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.


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References

  1. Rosenkranz S, Preston IR (December 2015). "Right heart catheterisation: best practice and pitfalls in pulmonary hypertension". Eur Respir Rev. 24 (138): 642–52. doi:10.1183/16000617.0062-2015. PMID 26621978.
  2. Guo X, Liu M, Ma Z, Wang S, Yang Y, Zhai Z, Wang C, Zhai R (2014). "Flow characteristics of the proximal pulmonary arteries and vena cava in patients with chronic thromboembolic pulmonary hypertension: correlation between 3.0 T phase-contrast MRI and right heart catheterization". Diagn Interv Radiol. 20 (5): 414–20. doi:10.5152/dir.2014.13501. PMC 4463330. PMID 25163757.
  3. Greiner S, Jud A, Aurich M, Hess A, Hilbel T, Hardt S, Katus HA, Mereles D (August 2014). "Reliability of noninvasive assessment of systolic pulmonary artery pressure by Doppler echocardiography compared to right heart catheterization: analysis in a large patient population". J Am Heart Assoc. 3 (4). doi:10.1161/JAHA.114.001103. PMC 4310406. PMID 25146706.
  4. D'Alto M, Romeo E, Argiento P, D'Andrea A, Vanderpool R, Correra A, Bossone E, Sarubbi B, Calabrò R, Russo MG, Naeije R (October 2013). "Accuracy and precision of echocardiography versus right heart catheterization for the assessment of pulmonary hypertension". Int. J. Cardiol. 168 (4): 4058–62. doi:10.1016/j.ijcard.2013.07.005. PMID 23890907.
  5. Hoeper MM, Lee SH, Voswinckel R, Palazzini M, Jais X, Marinelli A, Barst RJ, Ghofrani HA, Jing ZC, Opitz C, Seyfarth HJ, Halank M, McLaughlin V, Oudiz RJ, Ewert R, Wilkens H, Kluge S, Bremer HC, Baroke E, Rubin LJ (December 2006). "Complications of right heart catheterization procedures in patients with pulmonary hypertension in experienced centers". J. Am. Coll. Cardiol. 48 (12): 2546–52. doi:10.1016/j.jacc.2006.07.061. PMID 17174196.
  6. Taylor B, Rumbak M, Taylor SP, Solomon D (January 2013). "Early versus delayed right heart catheterization in evaluation of pulmonary arterial hypertension". J. Heart Lung Transplant. 32 (1): 137–8. doi:10.1016/j.healun.2012.10.004. PMID 23260714.

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