Sravanthi Ennala, MD
MD
Cleveland Clinic Foundation, United States
Disclosure information not submitted.
Celia Melillo, BS
Research Coordinator
Cleveland Clinic, United States
Disclosure information not submitted.
James Lane, RN
Critical Care Nurse
Cleveland Clinic, United States
Disclosure information not submitted.
Adriano Tonelli, MD, MSc
Respiratory and Critical Care Staff Physician
Cleveland Clinic, United States
Disclosure information not submitted.
Title: Effect of Pulmonary Artery Catheter Balloon Inflation on Pulmonary Hemodynamics
Introduction: A reliable pulmonary artery wedge pressure (PAWP) determination is essential for diagnosis and hemodynamic classification of pulmonary hypertension (PH). However, some physicians are concerned that the pulmonary artery catheter(PAC) balloon inflation(BI) in a pulmonary artery(PA) with already high mean pulmonary pressures (mPAP) may acutely affect the right ventricular(RV) afterload exposing patients to an increased risk of cardiovascular complications. So, we hypothesized that short-term BI has a minimal effect on pulmonary hemodynamics in most PH patients but may have a more relevant impact in those with severe PH.
Methods: Right heart catheterization was performed under local anesthesia by a single operator, with a 7.5 Fr PAC by advancing to the right or left main PA. Hemodynamic determinations (systolic, diastolic, and mPAP at end-expiration and across the respiratory cycle) were obtained in the PA, both with the balloon deflated and fully inflated (1.5 ml of air) just before advancing the PAC to a wedge position.
Results: We included 210 patients between December 2019 and December 2020, age 58 ± 14 years, 134 (64%) women. Patient had no PH (n:12,6%), PH group 1 (n:68,33%), 2 (n:86,41%), 3 (n:11,5%), 4 (n:29,14%), and 5 (n:3,1%).Group 1 PH included idiopathic (n:32,47%) and heritable PAH (n:7,10%), as well as PAH associated with liver disease (n:4,6%), connective tissue disease (n:22,32%) and drug/toxin (n:3,4%).The mean ± SD at end-expiration mPAP (balloon-up minus down) (n:209) was -0.02 ± 1.59 mmHg (range -5.0 to +4.0 mmHg, p=0.84), while the total pulmonary resistance (TPR) (n: 62) was -0.27 ± 1.2 Wood units (WU) (range -4.8 to +2.2 WU, p=0.08).For PH group 1, the mean ± SD difference in mPAP at end-expiration and TPR were 0.24 ± 1.79 mmHg (p=0.27) and -0.38 ± 1.41 WU (p=0.14) respectively. Interestingly, with BI, the mPAP averaged across the respiratory cycle was 0.54 ± 1.76 mmHg (p < 0.001) and 0.93 ± 1.89 mmHg (p < 0.001) higher for the entire cohort and the group of patients with PAH, respectively.
Conclusion: In this cohort of predominantly PH patients, we noted that BI of the PAC had no significant impact on the mPAP and TPR at end-expiration, supporting that PAC BI for PAWP determination has minimal hemodynamic implications in patients with PH and appears safe, even in patients with PAH.