Right_Heart_Catheterization

All patients with suspected pulmonary hypertension should undergo right heart catheterization with measurement of pulmonary hemodynamics, cardiac output and mixed venous oxygen saturation. The right heart catheterization also establishes pulmonary venous pressure (pulmonary artery occlusion pressure), allowing the type of pulmonary hypertension to be determined (precapillary vs postcapillary). In case of precapillary pulmonary hypertension, the right heart catheterization should be immediately followed by an acute vasodilator challenge in patients in whom symptoms and/or disease severity warrant treatment (mean PAP > 35 mmHg). Vasodilator testing has to be performed with short-acting agents such as inhaled nitric oxide, iv prostacyclin, iv adenosine or inhaled iloprost. Responders show their mean PAP decreased by more than 10 mmHg, to a value lower than 40 mmHg, with a normal or high cardiac output. Nonresponders exhibit no significant change in their mean pulmonary artery pressure or symptomatic systemic hypotension (decrease in systemic blood pressure > 20 % and no change or a decrease in cardiac output). Since cardiac output can not be determined by echocardiography, this examination is currently not recommended for vasodilator testing. Like angiography, right heart catheterization should be performed only in centres dedicated to the evaluation and treatment of pulmonary hypertension. Today, there are many new therapeutic options and ongoing clinical trials for these relatively rare disorders, and referal to centers establishes rapid access to optimal care for such patients.

Hemodynamic assessment

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