RESUMO
OBJECTIVES: To compare two methods of pulmonary arterial pressure measurement in children with shunt-dependent pulmonary blood flow. BACKGROUND: In children with shunt-dependent pulmonary blood flow, direct assessment of pulmonary arterial pressure requires passage of a catheter across the shunt. This can be technically difficult and dangerous. Use of the pulmonary venous wedge pressure offers an alternative but has not been validated in this patient population. METHODS: We prospectively studied 18 children with shunt-dependent pulmonary blood flow. Pulmonary venous wedge pressure and directly measured pulmonary arterial pressures were independently assessed by two blinded cardiologists. RESULTS: Directly measured mean pulmonary arterial pressure and pulmonary venous wedge pressure are closely correlated (R2 = 0.80, P < 0.01). Agreement between the two measures is improved at lower mean pressures with greater differences at higher pressures. For 20 of 24 ipsilateral measurements, pulmonary venous wedge pressure was > or = directly measured pulmonary arterial pressure. Pulmonary venous wedge pressure never underestimated pulmonary arterial pressure by more than 3 mm Hg. CONCLUSIONS: Pulmonary venous wedge pressure provides a safe and accurate means of estimating pulmonary arterial pressure in children with shunt-dependent pulmonary blood flow. The slightly lower pressures seen on direct measurement compared with the reverse pulmonary vein may reflect impairment of flow across the shunt by the catheter.
Assuntos
Determinação da Pressão Arterial/métodos , Cateterismo de Swan-Ganz , Cardiopatias Congênitas/fisiopatologia , Artéria Pulmonar/fisiopatologia , Circulação Pulmonar , Veias Pulmonares/fisiopatologia , Pressão Propulsora Pulmonar , Pressão Venosa , Adolescente , Procedimentos Cirúrgicos Cardíacos , Criança , Pré-Escolar , Circulação Coronária , Cardiopatias Congênitas/cirurgia , Humanos , Variações Dependentes do Observador , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos TestesRESUMO
We present four children with hypoplastic left heart syndrome (HLHS) and development of thrombus in the native aortic root. There are only two previously reported cases in the literature. In all four of our patients, thrombus was noted on transthoracic echocardiography. In one patient, surgical thrombectomy was performed, with subsequent deterioration and death. Thrombolysis was used in one patient, with suspected embolic events following his treatment. In the remaining two patients, medical management with chronic anticoagulation was successful in reducing the size of the thrombus.
