- The patient is a 3 year old female with a history of lung infections as an infant and diagnosis of congenital heart disease requiring surgery at age 1 year. - Examination found signs of right heart enlargement and a loud heart murmur. Echocardiogram showed a large ventricular septal defect with left-to-right shunting and mild pulmonary artery hypertension. - Cardiac catheterization was performed and found severe pulmonary artery hypertension with right ventricular and pulmonary artery pressures elevated. Oxygen saturations were low in the veins and pulmonary artery.

1. CATH MEET
MURTAZA KAMAL
03202020

2. History
• 3y/ f
• History of LRTI 2 episodes in infancy: Admitted for 3-4 days
• No h/o suck rest suck cycle, cyanosis
• Diagnosed to have CHD and advised surgery at 1 year of age
• Irregular follow up
• No admissions after 1 year of age
• Presented now for further management

3. O/E:
• GPE: wt: ht: BMI: No pallor, No clinical cyanosis, spo2: 94%
• Vitals: hr: 102/ min, RR: 20/ min, BP: 102/64 mm hg, Afebrile
• JVP: Short neck, could not be evaluated
• CVS: RV apex, grade 2 parasternal pulsations, epigastric pulsations+,
P2 palpable, UL 2nd ICS: Dull
• S1: N; S2: Single (p2) loud; S3+ S4: Absent
• No additional sound or murmur

4. ECG

6. CXR

7. 2D ECHO
• SS, Levocardia, Normal sy+ pul venous drainage, NRGS, AV- VA
concordance
• Large perimembranous VSD with BD shunt, predominantly lt rt
shunt
• Mild TR, RVSP: 90 mm hg, severe PAH
• Mildly dilated right heart
• Good BV function

8. Cardiac Cath
• 3 years old female
• WT: 9 kg, Ht: 90 cm, BMI: 11.1KG/m2, BSA: 0.43m2
• HB: 10.1 g/dl
• HR: 138/ min (CON 1), 121/ min (CON 2)
• 02 consumption: 178 (CON 1), 171 (CON 2) ml/min/m2
• INDICATION: Assessment of PA pressures and reversibility

9. Cath cont…
• GA, all aseptic precautions, vascular access seldinger technique
• Heparin: 100u/ kg
• Catheter course: RFV> IVC> RA> RV> PA
• RFA> AORTA> LV
• Condition 1+ 2

10. CON 1: FA

11. CON 1: AORTA+ PA

12. CON 1: AORTA+ PCWP

13. CON 1: AORTA+ RV

14. CON 1: AORTA+ RA

15. CON 1: SIMULTANEOUS LV+ RV

16. CON 1: LVEDP

17. CONDITION 2

18. CON 2: FA

19. CON 2: LV+ PCWP

20. CON 2: LVEDP+ PCWP

21. CON 2: AORTA+ LV

22. CON 2: LVEDP

23. CON 2: BOTH VENTRICLES

24. CON 2: AORTA+ RA

25. CATH DATA
CHAMBER CON 1 CON 2
FA 107/48//69 109/52//71
RA 22/8//12 13/8//11
RV 95/0-12 88/0-11
PA 91/50//69 83/35//58
LV 100/0-19 84/0-20
AORTA 96/55//73 89/42//63
CON1
SPO2
CON1
PO2
CON2
SPO2
CON2
PO2
SVC 66.1 45.3 83.3 60.9
IVC 61.6 42.2 80.6 56.7
PA 74.6 50.5 97.4 121
LV 93.4 82.3 99.6 440
FA 91.2 73.9 99.7 420

27. THANK YOU