Elsevier

Cardiology Clinics

Volume 22, Issue 3, August 2004, Pages 401-415
Cardiology Clinics

Review article
Cardiac catheterization techniques in pulmonary hypertension

https://doi.org/10.1016/j.ccl.2004.04.011Get rights and content

Section snippets

Indications and considerations for catheterization of the patient with pulmonary hypertension

Catheterization plays an integral part in the evaluation of the patient with pulmonary hypertension. The primary goals of catheterization are to determine right ventricular and pulmonary artery hemodynamics, to exclude left-to-right cardiac shunts and any significant left-sided cardiac disorder, to assist in the determination of the cause of pulmonary hypertension, and to test the response of therapeutic agents. In patients with suspected CTEPH, pulmonary angiography and angioscopy are used to

Safety considerations

Early case reports [1], [2], [3], [4] of fatalities associated with pulmonary angiography in patients with pulmonary hypertension have led to a lingering perception that the procedure is associated with considerable risk, primarily because of acute right ventricular failure and arrhythmias. Even right-heart catheterization alone [5] was reported to be potentially dangerous. Larger series have since been published, both in acute and chronic pulmonary embolism and in mild as well as severe

Right-heart catheterization

Evaluation of hemodynamics by right-heart catheterization plays an integral part of the evaluation of patients with pulmonary hypertension. The goals of right-sided catheterization are (1) to measure PAP directly and estimate pulmonary vascular resistance, (2) to evaluate for left-to-right shunts, and (3) to test the response to therapeutic agents.

During right-heart catheterization by balloon flotation catheter, rapid determination and continuous monitoring of pressures in the right ventricle,

Response of vasodilator challenge in the cardiac catheterization laboratory

Vasoconstriction of the pulmonary vessels is one of the prominent pathologic features seen in patients with pulmonary hypertension of any cause, particularly in those with PPH [14]. Unfortunately, no hemodynamic or demographic characteristics exist to predict which patients are likely to benefit from long-term vasodilator therapy [15], [16]. In more recent studies, Groves et al [17] illustrated that the initial response to vasodilatory therapy accurately predicts the patient with PPH who is

Pulmonary angiography: anatomy

Accurate evaluation of the pulmonary angiogram requires knowledge of the pulmonary vasculature anatomy (Fig. 2, Fig. 3). The main pulmonary artery arises from the pulmonary conus of the right ventricle, anterior and to the left of the aorta. It takes a posteromedial direction until its bifurcation into the right and left pulmonary arteries. The right pulmonary artery courses anterior to the right mainstem bronchus. It gives rise to the right upper lobe branch within the mediastinum. The left

Pulmonary angiography: interpretation in the patient with pulmonary hypertension

Pulmonary angiography of the patient with pulmonary hypertension plays a central role in delineating the precapillary cause of elevated pulmonary pressures. Distinguishing major-vessel from small-vessel disease allows the correct therapeutic approach to be determined.

Auger et al [26] described the angiographic patterns seen in patients with chronic thromboembolic disease. These patterns include pouching abnormalities, vascular webs or bandlike constrictions, intimal irregularities, abrupt

Pulmonary angioscopy

When there is significant proximal disease (eg, complete occlusions of lobar vessels), the interpretation of pulmonary angiograms is straightforward. In the UCSD experience the pulmonary angiogram is suggestive but not definitive in about 20% to 25% of cases. The recanalization of chronic clot allows contrast to permeate through the lesions, and the pulmonary angiogram can underestimate disease just as the perfusion scan can. In addition, the presence of defects at the transition between

Summary

Cardiac catheterization of the patient with pulmonary hypertension plays an integral part in the diagnostic evaluation. Right-heart hemodynamics, pulmonary angiography, and pulmonary angioscopy offer a way to determine the cause of disease safely and accurately and to offer potentially life-saving therapies.

First page preview

First page preview
Click to open first page preview

References (38)

  • P. Caldini et al.

    Primary pulmonary hypertension with death during right heart catheterization

    Am J Cardiol

    (1959)
  • S.R. Mills et al.

    The incidence, etiologies, and avoidance of complications of pulmonary angiography in a large series

    Radiology

    (1980)
  • P. Nicod et al.

    Pulmonary angiography in severe chronic pulmonary hypertension

    Ann Intern Med

    (1987)
  • S. Rich et al.

    Primary pulmonary hypertension: a national prospective study

    Ann Intern Med

    (1987)
  • K.L. Peterson et al.

    Catheterization and angiography in pulmonary hypertension

  • T. Kumazaki

    Ioxaglate versus diatrizoate in selective pulmonary angiographyPart II: cardiovascular responses

    Acta Radiol

    (1985)
  • D.C. Smith et al.

    Pulmonary angiography: comparison of cough stimulation effects of diatrizoate and ioxaglate

    Radiology

    (1987)
  • G.E. D'Alonzo et al.

    Survival in patients with primary pulmonary hypertension: result from a national prospective registry

    Ann Intern Med

    (1991)
  • L.W. Rubin et al.

    Primary pulmonary hypertension

  • Cited by (31)

    • Computed tomographic pulmonary angiography in the assessment of severity of chronic thromboembolic pulmonary hypertension and right ventricular dysfunction

      2011, European Journal of Radiology
      Citation Excerpt :

      Our results also showed the RVd/LVd was related with TVPG, maximum pulmonary valve velocity, right ventricular end-diastolic volume and RVEF, which suggested CTPA, might play an important role in the evaluation of pathophysiological changes of RV in patients with CTEPH. Right-heart catheterization has been widely used in the evaluation of hemodynamics of patients with PAH [27]. The parameters of hemodynamics obtained from heart catheterization can precisely assess the severity of PAH playing important roles in guiding clinical treatment and predicting the prognosis [28,29].

    • Pulmonary vascular disease

      2010, Paediatric Cardiology
    • Pulmonary Vascular Disease

      2009, Paediatric Cardiology
    View all citing articles on Scopus
    View full text