Page 20 - Journal of Structural Heart Disease Volume 3, Issue 4

Case Report
Journal of Structural Heart Disease, August 2017, Volume 3, Issue 4:107-110
DOI: https://doi.org/10.12945/j.jshd.2017.004.17
Received: February 02, 2017 Accepted: February 28, 2017 Published online: August 2017
Direct Left Atrial Pressure Measurement
with Pressure Sensing Wires in Complex
Univentricular Heart Disease
Eiméar McGovern, MB,BCh, BAO, MRCPCH*, Martin C. K. Hosking, FRCP(C), FACC,FAAP, Kevin C. Harris, MD,MHSc
Children’s Heart Centre, British Columbia Children’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
Abstract
In congenital heart disease, pressure-sensing wires provide an alternative method of obtaining important hemodynamic information when it cannot be obtained with traditional uid- lled catheters. Here, we illus- trate how pressure-sensing wires are vital for patients with univentricular heart physiology and an atrial stent in situ to prove candidacy for bidirectional cavopulmo- nary anastomosis.
Copyright © 2017 Science International Corp.
Key Words
Pressure wire • Congenital heart disease • Pediatric cardiology
Introduction
Pressure-sensing wires are guidewires, typically 0.014 inches in diameter, with high delity tip sensor technology for pressure measurement. In adult car- diology, their use has become routine for functional assessment of atherosclerotic coronary artery lesions by calculating fractional ow reserve [1]. This tech- nique has also been described in pediatric patients with Kawasaki disease [2], but few reports have been published on the use of pressure wires for pediatric patients with congenital heart disease.
In children with single ventricle physiology, the ac- curate measurement of pulmonary vascular resistance (PVR) is critical for assessing the suitability of bidirec-
tional cavopulmonary anastomosis. Occasionally, the sequelae of previous interventions may preclude the use of traditional uid- lled catheters to obtain this critical hemodynamic data. Pressure wires provide an alternative method of obtaining this information. Here, we present two cases in which the use of pres- sure wires allowed an accurate pre-surgical assess- ment and successful outcome where the absence of such data may have precluded surgical care.
Case Presentation
Two infants with complex univentricular heart dis- ease and atrial septal stents in situ were taken to the catheterization laboratory for pre-bidirectional cavo- pulmonary anastomosis evaluation. We used a stan- dard technique for pressure-sensing wire (St. Jude Medical pressure wire FFR Aeris Agile Tip 0.36mm in width, 175cm in length, St. Paul, MN) measurement [3]. An end-hole guiding catheter (Terumo 4/5-F) was placed proximal to the area of interest. A standard u- id- lled pressure transducer was attached to the cath- eter system. The sensor of the pressure wire was set to zero ex vivo. The wire was then inserted into the guide catheter until the tip extended just beyond the end of the catheter (still in the same vascular structure). In this position, we equalized the pressures registered by both the pressure wire and catheter. The pressure wire was advanced to the area of interest, and pres- sure was measured. Following measurement, with
* Corresponding Author:
Kevin C. Harris MD, MHSc
Children’s Heart Centre
British Columbia Children’s Hospital,
1F27 – 4480 Oak Street, Vancouver, British Columbia, Canada V6H3V4
Tel: +1 604 875 7546; Fax: +1 604 875 3463; E-Mail: emcgovern1987@gmail.com
Fax +1 203 785 3346
E-Mail: jshd@scienceinternational.org http://structuralheartdisease.org/
© 2017 Journal of Structural Heart Disease Published by Science International Corp. ISSN 2326-4004
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