Technique to Monitor Pulmonary Artery Pressure after Pediatric Cardiac Surgery

Abstract

Pulmonary hypertensive crisis is a recognized cause of sudden deterioration and death after correction of congenital heart disease. In phase 1 of this study, pulmonary artery pressure was monitored continuously in 200 high-risk children aged 9 days to 5 years using pulmonary artery pressure monitoring lines inserted through the right internal jugular vein. The success rate for placement of catheter tips in the pre-incision period was not high but all could be placed in the pulmonary artery before right atrial closure prior to separation from cardiopulmonary bypass. Complications related to the technique were transient ventricular or atrial arrhythmias during insertion and slipping or coiling of the catheter in the right ventricle. Carotid arterial puncture in 2 patients and pneumothorax in another 2 were additional complications. In phase 2, the directly measured pulmonary artery pressure was compared to that measured by echocardiography in 20 high-risk patients aged 7 days to 10 years weighing 2.6 to 26 kg. Systolic pulmonary artery pressure ranged from 16 to 58 mm Hg (mean, 38.1 ± 12.5 mm Hg) measured by the catheter and 21 to 54 mm Hg (mean, 39.7 ± 11.7 mm Hg) measured by echocardiography, showing excellent correlation (r = 0.97). Our study indicates that percutaneous insertion of a pulmonary artery pressure line in infants and children undergoing open-heart surgery is safe and practical for those at risk of postoperative pulmonary hypertensive crisis.