■肺动脉楔压(PAWP)可以低估直接测量的肺静脉压(PVP),如动物研究和人类病例报告所示。这一概念尚未在更大的小儿肺静脉狭窄(PVS)患者队列中得到验证。
■从2018年1月1日至2023年3月31日在单个中心接受PVS心脏导管插入术的儿科患者进行了回顾性审查。PAWP与直接测量的PVP或LA压力之间的不匹配定义为>3mmHg。检查介入前血管造影并计算狭窄百分比。
■26例患者符合纳入标准;51例下肺静脉(左34,评估了42个导管插入术中的17个)。38/51(75%)静脉可见明显PVS(≥30%狭窄),和9/51(18%)静脉没有血管造影狭窄(0%狭窄)。PAWP-PVP不匹配发生在37/51(73%)静脉中,中位差异为8mmHg(IQR,6-12).其中,在26例中,PAWP等于LA压力,所有这些都有显著的PVS(中位狭窄率54[IQR,45-60]).6例PAWP-PVP不匹配,PVS(范围,41%-70%狭窄),并且没有PAWP-LA不匹配报告近端和远端节段PAWP。在所有6个实例中,没有远端PAWP-PVP不匹配(中值差1mmHg[范围,0-3])。
■在这项针对小儿PVS患者的单中心研究中,PAWP明显低估了直接测量的下肺静脉PVP。远侧叶段中的球囊楔形或端孔导管位置可以更准确地估计PVP。
UNASSIGNED: Pulmonary artery wedge pressure (PAWP) can underestimate directly measured pulmonary vein pressure (PVP) as demonstrated in animal studies and human case reports. This concept has not been validated in a larger cohort of pediatric patients with pulmonary vein stenosis (PVS).
UNASSIGNED: Pediatric patients who underwent cardiac catheterization for PVS at a single center from January 1, 2018, to March 31, 2023, were retrospectively reviewed. Mismatch between the PAWP and directly measured PVP or LA pressure was defined as >3 mm Hg. Preintervention angiography was reviewed and percent stenosis calculated.
UNASSIGNED: Twenty-six patients met inclusion criteria; 51 lower pulmonary veins (34 left, 17 right) from 42 catheterizations were evaluated. Significant PVS (≥30% stenosis) was seen in 38/51 (75%) veins, and 9/51 (18%) veins had no angiographic narrowing (0% stenosis). PAWP-PVP mismatch occurred in 37/51 (73%) veins with a median difference of 8 mm Hg (IQR, 6-12). Of these, PAWP was equal to LA pressure in 26 instances, all of which had significant PVS (median % stenosis 54 [IQR, 45-60]). Six of the cases with PAWP-PVP mismatch, PVS (range, 41%-70% stenosis), and no PAWP-LA mismatch reported both a proximal and distal segmental PAWP. In all 6 instances, there was no distal PAWP-PVP mismatch (median difference 1 mm Hg [range, 0-3]).
UNASSIGNED: In this single-center study of pediatric patients with PVS, PAWP significantly underestimated directly measured PVP in lower pulmonary veins. Balloon wedge or end hole catheter position in a distal lobar segment may more accurately estimate the PVP.