The semi-elective use of the pulmonary artery flotation catheter in children with progressive pulmonary hypertension or left ventricular dysfunction.

Abstract

OBJECTIVE: To describe the experience with the semi-elective use of the pulmonary artery flotation catheter in pediatric patients with progressive pulmonary hypertension or left ventricular dysfunction. DESIGN: Prospective study. SETTING: Pediatric intensive care unit in a tertiary care center. PATIENTS: Seven consecutive children with pulmonary hypertension and ten children with left ventricular dysfunction. INTERVENTIONS: Drug-response studies were performed using a pulmonary artery flotation catheter. Cardiac index, systemic and pulmonary blood pressure, and occlusion pressure were measured during incremental doses of calcium channel blocker (diltiazem) that were administered to children with pulmonary hypertension and during incremental doses of nitroglycerine and angiotensin-converting enzyme-inhibitor (captopril) that were administered to patients with left ventricular dysfunction. MAIN RESULTS: Four patients (60%) with pulmonary hypertension were identified as responders to calcium channel blockers, resulting in maintenance therapy with high-dose diltiazem in three of them. Nine patients (90%) with left ventricular dysfunction showed a >15% increase in cardiac index with vasodilator therapy. Eleven patients (65%) developed fever during the procedure. Nine patients (53%) had a high probability of bacterial infection. Seven patients (40%) died within 3.5 months after the procedure. Fever, infection, and mortality appeared to occur more frequently in patients in New York Heart Association classes III and IV. CONCLUSIONS: The use of a pulmonary artery flotation catheter enables us to optimize medical treatment strategies in the individual child with progressive pulmonary hypertension or left ventricular dysfunction. Children with left ventricular dysfunction in poor clinical condition showed a high mortality rate post or propter the procedure. In our opinion, drug-response studies using pulmonary artery flotation catheters in patients with left ventricular dysfunction should be performed in a relatively early stage of the disease.