Pulmonary pressure in the first twelve-months of live: What should we expect? - 20/09/24
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Résumé |
Introduction |
Mean pulmonary artery pressure (mPAP)≥20mmHg defines pulmonary hypertension (PH).
Objective |
Critically evaluate this cut-off in very young patients.
Methods |
In total, 1129 consecutive patients had a reliable mPAP measurement between 1–12months of life. These invasive measurements and their clinical history were reviewed.
Results |
Age was mean±SD 158±100days, weight 5.5±1.9kg. Patients with a palliated single ventricle anatomy 129/1129, peripheral PA-branch stenosis or MAPCAs 45/1129, PA-banding for open shunt 30/1129, or severe RVOTO 185/1129 were excluded. Of the remaining 726 patients 163/726 (22%) had mPAP<20mmHg while 563 (78%) had PH with mPAP≥20mmHg.
Overall, PH at TTE was the reason for invasive mPAP measurement in 236 patients and only 16/236 patients (7%) had a mPAP<20mmHg but 12/16 (75%) had a mPAP≥18mmHg. In the group with mPAP≥20mmHg PH persisted at 6-months in 109/236 (46%) (Fig. 1A) and in 68/236 (28%) at long-term follow-up (Fig. 1B). In the group with mPAP between 18 and 20mmHg PH persisted at 6-months in 9/12 (75%) and in 3/12 (25%) at long-term follow-up. None of the patients with mPAP<18mmHg had PH at follow-up.
In patients with less than 3months of age, PH at TTE was the reason for invasive mPAP measurement in 73/306 (23%) and only 3/73 patients (4%) had a mPAP<20mmHg, but 2/3 (75%) had a mPAP≥18mmHg. In the group with mPAP≥20mmHg PH persisted at 6-months in 34/70 (48%) (Fig. 2A) and in 34/70 (48%) at long-term follow-up (Fig. 2B). In the group with mPAP between 18 and 20mmHg PH persisted at 6-months in 2/2 (100%) and in 2/2 (100%) at long-term follow-up. None of those with mPAP<18mmHg had PH at follow-up.
Conclusion |
Pulmonary hypertension defined by mPAP≥20mmHg is very common in this cohort of young patients, especially in case of suspected PH at echo. A different cut-off defined as 18mmHg should be discussed in patients with less than 12-months.
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Vol 117 - N° 8-9S
P. S220 - août 2024 Retour au numéro
Article précédent
- Pulmonary hypertension (PH) in the first twelve-months of live: Long-term outcome in relation to diagnosis and invasive hemodynamic
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