Abstract
Cardiac catheterization of childhood pulmonary arterial hypertension (PAH) plays a pivotal role in the assessment of severity of the disease, prognosis, selection of the most adequate pulmonary vasodilators, and evaluation of effectiveness. However, sudden deterioration of cardiovascular hemodynamics can be easily induced by pain, patientʼs agitation, catheter manipulation, and by vasodilator provocation tests, which could evoke a pulmonary hypertension crisis, vagotony, respiratory distress, and hemoptysis resulting in critical complications, including death. Those patients with NYHA functional class 4 are especially at high-risk. It is noteworthy that pulmonary arteriography is a contraindication in patients with PAH.In a review of 7,218 adult patients, 76 (1.1%) serious complications, including 4 deaths, were reported; as for pediatric population, 29 cases (10.7%) out of 270 patients, including one with cardiogenic shock requiring cardiopulmonary resuscitation in addition to minor complications, were reported.For prevention of serious complications, basic and routine precautions such as oxygen administration and concomitant monitoring of SpO2, as well as ECG during transportation to and from the catheter laboratory, are mandatory. Furthermore, the cooperation of experienced physicians and well informed co-medicals in addition to meticulous preparation, e.g. prior doses calculation of catecholamine and confirmation of the presence of emergency equipment, are required.
