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Basic Pulmonary Hemodynamics Correlated to Pulmonary Vascular Resistance in Pulmonary Hypertension Related to Congenital Heart Disease in Children

T Benjapondsapun

Pirapon Momsila

S Patipanvat

Alisa Limsuwan

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Conference: 2018 PHA International PH Conference & Scientific Sessions

Release Date: 06.28.2018

Presentation Type: Abstracts

File Download: Conference 2018_1043

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2018 International PH Conference and Scientific SeAbstract presented at the 2018 International PH Conference and Scientific Sessions in Orlando, Fla., June 28-July 1, 2018.

Background

In majority of pediatric cardiology practice worldwide, the derived calculated pulmonary vascular resistance (PVR) has been used as a parameter to evaluate children with pulmonary hypertension associated with congenital heart disease (PH/CHD). It has been debated whether the PVR is the ideal parameter to reflect the severity of PH/CHD due to its derived calculated value depends on oxygen consumption.While measuring oxygen consumption (VO2) is difficult and complicated to obtain the accurate value, therefore estimated VO2 from reliable reference has been utilized in many centers. To avoid using VO2, the ratio between the PVR and systemic vascular resistance or Rp/Rs has been used instead of PVR. The objective of this study is to define whether the basic pulmonary hemodynamic parameters could be used as parameters to correlate with PVR and Rp/Rs .

Methods

Methods: Children with PH/CHD underwent cardiac catheterization. Derived calculated PVR was calculated from transpulmonary pressure gradient divided by the pulmonary blood flow. The PVR was tested and showed to be directly correlated with the Rp/Rs.The pulmonary hemodynamics especially the diastolic pulmonary pressure (dPAP), diastolic pressure gradient (DPG: difference between the dPAP and pulmonary capillary wedge pressure) ,pulmonary pulse pressure (PPP:difference between the systolic pulmonary pressure and dPAP) and pulmonary artery proportional pulse pressure ( PApPP) were compared and correlated with the PVR. The sensitivity and specificity of the pulmonary hemodynamic threshold value predict the PVR were determined.

Results

The cardiac catheterization data of 65 children (mean age 6.37 years, range1-21 years , 34 male) was retrospectively reviewed. The dPAP, DPG and PPP were correlated with the PVR, r=0.81,0.80 and 0.59 respectively. The dPAP > 19 mmHg had 85 % sensitivity and 71 % specificity to predict PVR > 3 WU.m² with area under the curve of 0.85. The ratio of the DPG > 11 mmHg had 82 % sensitivity and 78 % specificity to predict PVR > 3 WU.m² with area under the curve of 0.837. The PPP > 21 mmHg had 85 % sensitivity and 66% specificity to predict PVR > 3 WU.m² with area under the curve 0.891. While the PAPPP was not correlated to the PVR.

Conclusions

The basic pulmonary hemodynamics particularly the dPAP DPG and PPP could be used to assess PH/CHD in children with reasonable correlation with the PVR. The direct measurement of dPAP has a better prediction of the PVR in comparison with the DPG and PPP.