Pulmonary Artery Pressure In Children Research Articles

Pulmonary venous wedge pressure provides an accurate assessment of pulmonary artery pressure in children with a bidirectional Glenn shunt.

In circulations with pulsatile pulmonary artery flow the pulmonary venous wedge pressure (PVWp) has been validated as a good estimate of pulmonary artery pressure (PAp), when PAp is low. The purpose of this study was to validate PVWp estimates of PAp in the less-pulsatile pulmonary circulation of children after bidirectional Glenn shunts. A retrospective study was performed of 22 simultaneous measurements of PVWp and PAp made during 20 catheterizations in 19 children who had undergone bidirectional Glenn procedures. The PAp was measured directly from the branch PA ipsilateral to the side of the PVWp, or in the SVC. Pulmonary resistance (Rp) was calculated with both PAp and PVWp, to assess the impact of PAp estimates on Rp determinations. Patients ranged in age from 5 months to 10.7 years. There were a variety of univentricular cardiac malformations in the study group. Two children had antegrade pulmonary blood flow in addition to a bidirectional Glenn shunt. The mean PAp ranged from 4 to 14 mmHg, while mean PVWp ranged from 3 to 15 mmHg. Mean PVWp never differed from mean PAp by more than 3 mmHg. There was a significant linear relation between mean PAp and PVWp: PAp = 0.86 (PVWp) + 2.0 (R2 = 0.89; P < 0.0001). PVWp provided a good approximation of PAp regardless of the presence (n = 2) or absence (n = 19) of antegrade pulmonary flow. There was a good linear correlation between the Rp calculated by both methods (RpPAp = 0.9 (RpVWp) + 0.5; R2 = 0.74; P < 0.0001). The mean PVWp provides a close approximation of mean PAp in children with a bidirectional Glenn shunt and provides valuable hemodynamic information in cases where direct PAp measurements are unavailable.

The efficacy of using pulmonary vein wedge pressure for the estimation of pulmonary artery pressure in children with congenital heart disease.

The objectives of this study were to assess the accuracy of pulmonary vein wedge pressure (PVWP) in estimating pulmonary artery pressure (PAP) in various types of congenital heart disease, including single-ventricle physiology. The systolic, diastolic, and mean values of both PAPs and PVWPs were measured in 30 patients (a total of 46 points). Pulmonary artery pressure ranged from 13 to 74 (34 +/- 15) mm Hg in systole, 5 to 25 (13 +/- 6) mm Hg in diastole, and 6 to 48 (18 +/- 10) mm Hg in mean. As a whole, good correlations between PAPs and PVWPs were observed (systole, r = 0.70; diastole, r = 0.85; mean, r = 0.82; P < 0.0001). However, with an increase in PAP, the discrepancy between PAPs and PVWPs increased. When the mean PVWP was more than 18 mm Hg, the mean PVWP in 14 of 24 (58%) underestimated the mean PAP by up to 22 mm Hg (mean difference, -1.7 +/- 5.8 mm Hg). On the other hand, all of the patients with mean PVWPs less than 18 mm Hg (n = 22) had mean PAPs less than 18 mm Hg (r = 0.86; PAP = 1.11 x PVWP - 1.41; P < 0.0001), and the mean difference was -0.2 +/- 1.8 mm Hg. The mean PVWP can accurately estimate the mean PAP in children with congenital heart disease who have a mean PVWP less than 18 mm Hg.

Doppler echocardiographic evaluation of pulmonary artery pressure in children with acute pneumonia.

In this prospective study 37 children (ranging 2 months-15 years) with acute pneumonia were evaluated by Doppler echocardiography for the presence of pulmonary hypertension (PH). The goal of this study was to determine the frequency of PH in children with acute pneumonia because the diagnosis of PH influenced the treatment of pneumonia in these patients. The patients who had more than 35 mmHg of systolic pulmonary arterial pressure were considered to have PH. In our study PH was found in 15 (40.5%) of 37 patients. We did not find any significant difference for the parameters including the age, weight, height, clinical symptoms and signs (fever, cough, dyspnea, tachycardia and tachypnea etc.), and laboratory findings such as hemoglobin, PCO2, HCO3 and PO2 between the patients with and without PH (p>0.05). However, there was a significant difference in cyanosis, cardiac failure, blood pH level and O2 saturation measured by pulse oximetry between the patients with and without PH (p<0.05).

Doppler echocardiographic evaluation of pulmonary arterial pressure in children with allergic rhinitis

In children, persistent upper airway obstruction may lead to increased pulmonary arterial pressure (PAP). Allergic rhinitis (AR) is one of the frequent cause of persisting upper airway obstruction by nasal blockage in childhood. Regular use of nasal topical corticosteroids are effective in reducing nasal blockage and obstruction. However, whether symptomatic children with AR have increased PAP and curative effect of topical steroids are not known. The aims of this study were to clarify whether children having active symptoms of AR have increased PAP and to investigate the curative effect of reducing nasal obstruction by topical corticosteroids. Twenty-three children, aged between 5 and 16, diagnosed as AR, consisted of 17 seasonal AR (SAR) and seven perennial AR (PAR), were included in the study. Nineteen age and sex matched healthy children were received as controls. PAP was measured by using Doppler echocardiography in all subjects and symptom scores of AR were recorded in rhinitis group. After first evaluation, nasal steroid, budesonid, was given to rhinitis group for three months. Mean systolic PAP was 33.4±3.1 for children with AR mmHg and 23.6±4.3 mmHg for the control group. The difference was statistically significant ( P<0.05). Mean systolic PAP of children with PAR was significantly higher than children with SAR ( P<0.05). In rhinitis group, mean PAP decreased significantly after relief of upper airway obstruction by nasal corticosteroid therapy to normal level of 24.9±3.6 mmHg ( P<0.05). Our results showed that children with AR may have significantly higher PAP than healthy subjects and decreased to normal levels after relieving nasal blockage by nasal corticosteroids. Nevertheless, Doppler echocardiography is a safe, non-invasive and practical tool for cardiac investigation of children with AR. Therefore, in symptomatic period, evaluation of PAP of children with AR by using Doppler echocardiography may be useful in the planning and following of their therapy.

366 Non-invasive methods for determining the pulmonary arterial pressure in children with bronchial asthma

366 Non-invasive methods for determining the pulmonary arterial pressure in children with bronchial asthma

Continuous low dose inhaled nitric oxide for treatment of severe pulmonary hypertension after cardiac surgery in paediatric patients.

To assess the effect of inhaled nitric oxide (NO) on severe postoperative pulmonary hypertension in children after surgical repair of a congenital heart defect. A pilot study of NO administration to 7 consecutive children who required adrenergic support and in whom postoperative mean pulmonary artery pressure was more than two thirds of mean systemic pressure and persisted despite alkalotic hyperventilation. Routine care after cardiac surgery for congenital heart disease in a multidisciplinary paediatric intensive care unit. Continuous inhalation of NO, initially at 15 ppm. Therefore, daily attempts at complete weaning or at reducing NO to the lowest effective dose. In 6 of the 7 children NO inhalation selectively decreased mean (SD) pulmonary artery pressure from 51 (12) to 31 (9) mm Hg (P < 0.05) while mean systemic arterial pressure was unchanged (68 (10) v 71 (7) mm Hg) (NS) and the arteriovenous difference in oxygen content decreased from 6.7 (0.9) to 4.8 (0.8) vol% (P < 0.05). Concomitantly PaO2 increased from 158 (98) to 231 (79) mm Hg) (P < 0.05). The seventh child showed no response to NO up to 80 ppm, could not be weaned from cardiopulmonary bypass, and died in the operating room. In responders, attempts at early weaning from NO inhalation always failed and NO at concentrations of less than 10 ppm was continuously administered for a median of 9.5 days (range 4 to 16 days) until complete weaning was possible from a mean dose of 3.9 (2.9) ppm. Methaemoglobinaemia remained below 2% and nitrogen dioxide concentrations usually ranged from 0.1 to 0.2 ppm. One child later died and five were discharged. A few months after surgery Doppler echocardiography (and catheterisation in one) showed evidence of regression of pulmonary hypertension in all 5. Inhalation of NO reduced pulmonary artery pressure in children with severe pulmonary hypertension after cardiac surgery and this effect was maintained over several days at concentrations carrying little risk of toxicity.

Hyperoxia and alkalosis produce pulmonary vasodilation independent of endothelium-derived nitric oxide in newborn lambs.

Supplemental oxygen and alkalosis are the most effective treatments used to lower pulmonary arterial pressure in children with pulmonary hypertensive disorders. However, their mechanisms of action are unknown. Endothelium-derived nitric oxide (EDNO) is an important mediator of pulmonary vascular tone and produces potent pulmonary vasodilation during pulmonary hypertension. In vitro evidence suggests that EDNO may mediate the vasodilating effects of oxygen. To investigate whether EDNO synthesis mediates the pulmonary vasodilation produced by hyperoxia [normocarbic ventilation with 100% oxygen, arterial oxygen tension > 450 torr (60 kPa)] or alkalosis (hyperventilation with 21% oxygen, pH > 7.55) in vivo, eight intact newborn lambs were studied during similar degrees of pulmonary hypertension induced either by the infusion of U46619 (a thromboxane A2 mimic) or N omega-nitro-L-arginine (an inhibitor of EDNO synthesis). The lambs were sedated, paralyzed, and mechanically ventilated. Meclofenamic acid was infused to inhibit prostaglandin synthesis. During pulmonary hypertension induced by U46619, pulmonary arterial pressure and pulmonary vascular resistance were significantly decreased by acetylcholine (an EDNO-dependent vasodilator) (23.1 +/- 3.4% and 43.3 +/- 14.5%, respectively), hyperoxia (26.8 +/- 7.8% and 32.9 +/- 10.6%), and alkalosis (32.1 +/- 10.3% and 36.1 +/- 17.0%) (p < 0.05). During pulmonary hypertension induced by N omega-nitro-L-arginine, the decreases in pulmonary arterial pressure and pulmonary vascular resistance produced by acetylcholine (9.6 +/- 6.4% and 23.9 +/- 14.1%, respectively) were significantly attenuated (p < 0.05), but the decreases produced by hyperoxia or alkalosis were unchanged. Therefore, hyperoxia and alkalosis can produce pulmonary vasodilation independent of EDNO synthesis in the intact newborn lamb.

Determination of Pulmonary to Systemic Flow Ratio and Prediction of Pulmonary Arterial Pressure in Children by Pulsed Doppler Echocardiography

Determination of Pulmonary to Systemic Flow Ratio and Prediction of Pulmonary Arterial Pressure in Children by Pulsed Doppler Echocardiography

Factors affecting use of the Doppler-determined time from flow onset to maximal pulmonary artery velocity for measurement of pulmonary artery pressure in children

Measurement of the time from onset to maximal or peak velocity (TPV) of pulmonary artery (PA) flow has been proposed as a noninvasive means of determining PA pressure. The effects of age, heart rate, increased PA pressure and flow, pulmonary valve obstruction and altered PA vascular resistance on this measurement were evaluated. In 84 children, aged 1 day to 18 years, TPV was measured using continuous-wave Doppler echocardiography. The children were separated into 3 groups. Group I (n = 33) consisted of children with no cardiovascular abnormalities. Group II (n = 33) consisted of children with a variety of cardiovascular diseases producing varying PA pressures and flows. Group III (n = 18) consisted of children who had valvular pulmonic stenosis with PA to right ventricular gradients greater than 40 mm Hg. Doppler studies of group II and III patients were performed in conjunction with measurement of PA pressures and flows at the time of cardiac catheterization. In group I TPV showed a significant negative linear correlation with heart rate (r = −0.86, p < 0.001). The ratio of observed TPV to predicted TPV (TPVN) determined using the regression equation for TPV vs heart rate or TPV/TPVN was heart rate- and age-independent (p > 0.1) and ranged from 0.81 to 1.31 (mean 1.005). In group II TPV/TPVN was inversely related to the natural log of the PA pressures (systolic, r = −0.91; mean, r = −0.87; diastolic, r = −0.82; all p < 0.01), whether pressure elevation was due to increased flow, resistance or left atrial hypertension. It was not affected by increased flow in the absence of pressure elevation. In group III TPV/TPVN was prolonged beyond that expected for the PA pressures and beyond the group I range, but did not correlate with transvalvular pressure gradient. Changes in TPV/TPVN reflect changing PA input characteristics due to either decreasing vascular capacitance from pressure elevation or increased resistance from valvular obstruction.

Continuous-wave Doppler in children with ventricular septal defect: Noninvasive estimation of interventricular pressure gradient

Continuous-wave Doppler was used to estimate the pressure gradient between the right and left ventricles in 28 children with ventricular septal defect (VSD). Doppler measurement of maximal velocity was performed during cardiac catheterization and the Doppler-predicted gradient was compared with the peak-to-peak gradient measured simultaneously by catheter. Doppler gradients ranged from 10 to 71 mm Hg and correlated well with measured gradient (r = 0.97, p < 0.001). Fourteen patients had isolated VSD, and in these patients Doppler measurements of gradient allowed accurate estimation of right ventricular pressure (r = 0.93). There was an inverse correlation between the ratio of pulmonary to systemic resistance and maximal velocity (r = −0.77). Thus, continuous-wave Doppler is an accurate means of measuring instantaneous VSD pressure gradient in children with congenital heart disease and can be used to estimate the right ventricular and pulmonary artery pressure in children with isolated VSD. This noninvasive method can be used to distinguish restrictive from nonrestrictive VSD.

Relation between Systolic and Diastolic Time Intervals of Right and Left Ventricles Measured with Echocardiography and Pulmonary Artery Pressure in Children with Congenital Heart Disease

Relation between Systolic and Diastolic Time Intervals of Right and Left Ventricles Measured with Echocardiography and Pulmonary Artery Pressure in Children with Congenital Heart Disease

Relation between isovolumic relaxation period of left ventricle and pulmonary artery pressure in d-transposition of the great arteries.

The study aimed to identify the best echocardiographic time interval (systolic or diastolic) for assessing pulmonary artery pressure in children with d-transposition of the great arteries. Echocardiograms were performed in 21 children with d-transposition of the great arteries within 48 hours of cardiac catheterisation. None of the children had had a Mustard procedure. Twenty-four recordings were obtained, three patients having been catheterised twice. Highest correlations were found for the ratio of the isovolumic relaxation time over the ejection time of the left ventricle (IRT/LVET) to the systolic pressure in the pulmonary artery and also between IRT/LVET and the difference between mean pulmonary artery pressure and mean left atrial pressure. All patients with a negative IRT/LVET ratio had a pulmonary systolic pressure lower than 35 mmHg and a mean pulmonary pressure lower than 25 mmHg. In patients with d-transposition, a negative IRT/LVET ratio appears to be a reliable indication of normal pressure in the pulmonary circulation. Serial echocardiographic studies for the follow-up of patients with d-transposition should include measurement of the time of relaxation of the left ventricle.

Echocardiographic assessment of pulmonary arterial pressure in children with complete right bundle branch block

The time interval between tricuspid valve closure and pulmonary valve opening, termed the isovolumic contraction time of the right ventricle, was evaluated echographically in 38 normal children and within 24 hours of cardiac catheterization in 53 children with congenital heart disease and normal conduction as assessed with the electrocardiogram. In the 53 patients with congenital heart disease, isovolumic contraction time was strongly influenced by right ventricular afterload, as defined by pulmonary arterial end-diastolic pressure ( r = 0.87). It was possible to utilize isovolumic contraction time to separate patients with normal or elevated values for pulmonary arterial end-diastolic pressure. Similar correlations were demonstrated between isovolumic contraction time and mean pulmonary arterial pressure and calculated pulmonary vascular resistance. Evaluation of 15 children with complete right bundle branch block revealed values for isovolumic contraction time that did not significantly differ from those of patients with similar pulmonary arterial end-diastolic pressure but no conduction abnormalities. These findings indicate that serial echographic evaluation of the interval from tricuspid valve closure to pulmonary valve opening can give an accurate reproducible assessment of right ventricular afterload in many children with congenital heart disease and complete right bundle branch block.

Simplified vectorcardiographic method for assessment of pulmonary arterial pressure in children with chronic rheumatic mitral valve disease.

We previously reported that pulmonary artery pressures can be assessed in children with chronic rheumatic mitral valve disease by measuring right maximum spatial vector from Frank vectorcardiogram. To simplify the calculation, pulmonary artery systolic pressure was correlated with maximum negative deflection on Frank scalar X-lead (SX), maximum negative deflection on scalar Z lead (SZ), sum total of SX and SZ (SX+SZ) and combined SX and SZ. The patient material consisted of 30 children with chronic rheumatic mitral valve disease, aged 8-14 1/2 years. Eleven were male and 19 were female. Sixteen had mitral stenosis, 8 had mitral regurgitation, and 6 had combined mitral regurgitation and stenosis, documented by cardiac catheterization and angiocardiographic study. The results showed a significant correlation between pulmonary artery systolic pressure and SX (r=0.782). As calculation of SX is considerably easier and less time consuming than that of right maximum spatial vector, this simplified method is preferable to right maximum spatial vector for prediction of the pulmonary artery systolic pressure of children with pulmonary hypertension due to chronic rheumatic mitral valve disease.

Relation of pulmonary arterial pressure to pressure in the pulmonary venous system.

ArticleRelation of pulmonary arterial pressure to pressure in the pulmonary venous system.T C Lloyd Jr, and A J SchneiderT C Lloyd JrSearch for more papers by this author, and A J SchneiderSearch for more papers by this authorPublished Online:01 Oct 1969https://doi.org/10.1152/jappl.1969.27.4.489MoreSectionsPDF (2 MB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations ShareShare onFacebookTwitterLinkedInWeChat Previous Back to Top Next Download PDF FiguresReferencesRelatedInformation Cited ByThe efficacy of using pulmonary vein wedge pressure for the estimation of pulmonary artery pressure in children with congenital heart disease27 January 2003 | Catheterization and Cardiovascular Interventions, Vol. 58, No. 2The Pathophysiology of Pulmonary Vascular Disease Associated with Congenital Cardiac LesionsPulmonary lymphatic flow alterations during intracranial hypertension in sheepAnnals of Neurology, Vol. 15, No. 2Experimental neurogenic pulmonary edemaJournal of Neurosurgery, Vol. 54, No. 5An analysis of the pulsatile hemodynamic responses of the pulmonary circulation to acute and chronic pulmonary venous hypertension in the awake dog.Circulation Research, Vol. 47, No. 6Centrogenic pulmonary hemorrhagic edema induced by cerebral compression in rats. Mechanism of volume and pressure loading in the pulmonary circulation.Circulation Research, Vol. 47, No. 3Supravalvular mitral stenosis associated with tetralogy of FallotThe American Journal of Cardiology, Vol. 37, No. 1Variations in pulmonary gas exchange due to changes in pulmonary artery pressure and flowJournal of Surgical Research, Vol. 18, No. 4Comparison of pulmonary artery and pulmonary venous wedge pressure in congenital heart disease.Heart, Vol. 35, No. 4Pulmonary Hypertension in Disorders of the Left Heart Observations in a Catheterization Material8 July 2009 | Scandinavian Journal of Clinical and Laboratory Investigation, Vol. 31, No. 4Hemodynamic effects of isoproterenol on the pulmonary and systemic circulations in dogsPfl�gers Archiv European Journal of Physiology, Vol. 322, No. 4Anomalous Systemic Arterial Supply to the Lung Causing Pulmonary-Artery HypertensionNew England Journal of Medicine, Vol. 283, No. 20 More from this issue > Volume 27Issue 4October 1969Pages 489-97 https://doi.org/10.1152/jappl.1969.27.4.489PubMed4390411History Published online 1 October 1969 Published in print 1 October 1969 Metrics

Pulmonary ‘Capillary’ Pressure in Man

<i>Pulmonary ‘Capillary’ Pressure in Man</i>