RHC in PHTN

WHY RHC in PHTN?

Doppler estimates
of PAP inaccurate
in 50% cases.

• Rich JD, Shah SJ, Swamy RS, Kamp A, Rich S. Inaccuracy of Doppler echocardiographic estimates of pulmonary artery pressures in
patients with pulmonary hypertension: implications for clinical practice. Chest. 2011 May;139(5):988-993.
Role Of RHC in PHTN
• Confirm the diagnosis
• Classification of PHTN
• Guides Therapy
 PAC
Blue lumen: used for CO, D5W injectate
bolus syringe, CVP and right atrial
pressure and infusion.

White lumen: used for IV fluid/medication

infusion.

Yellow lumen: connected to transducer

assembly. It is the distal port at the
catheter tip, 110 cm. Distal tip should be
located in the pulmonary artery, except
when repositioning.

•Red lumen: balloon port, syringe

attached and system locked. Never
inflate longer than 15 seconds
PAC Insertion site

IJV
Brachial vein
Femoral vein
Tracing of pulmonary artery pressure

RAP 0-5 mm of Hg RVP PAP PCWP: 0-8 mm of Hg

S: 10-20 mm of Hg S: 20-30 mm of Hg
D: 0-8mm of Hg D: 8-15 mm of Hg
Klabunde RE. Cardiovascular Physiology Concepts. 3rd ed. LWW; 2021.
 Changes in RAP in PAH

Abnormal PAP waveforms:

Elevated Systolic pressure

IPH
PE
Pulmonary dis (hypoxemia with Pulmonary vc)
RCM
MS/MR
Significant L R shunt

Elevated v wave and prominent y descent in TR

• Pressure traces taken
from a patient with
pulmonary arterial
hypertension. Trace A
shows very high
pulmonary artery
pressure (mean 75 mm
Hg). Trace B shows the
normal pulmonary
capillary wedge
pressure, confirming
that the elevated
pulmonary pressures are
due to precapillary
pulmonary vascular
disease. Note that the
wedge pressure is
under-damped with
marked artefact.
Definition
When to
do RHC?
 Pulmonary HTN- Recommendations for RHC and
VRT
Recommendations for RHC: class Level a b

It is recommended that RHC is performed to confirm the diagnosis of PH. (especially PAH & CTEPH) I B
and to support the treatment decision.
In patients with suspected or known PH, it is recommended to perform RHC in experienced centres. I C
It is recommended RHC comprises a complete set of hemodynamics and is performed following a I C
standardized protocol.
Recommendations for Vasoreactivity testing:
Vasoreactivity testing is recommended in patients with Idiopathic, Hereditary, Drug-induced PAH to I B
detect those who can be treated with high doses of CCB.
It is recommended that Vasoreactivity testing is performed at PH centres. I B
It is recommended to consider a positive response to Vasoreactivity testing by a reduction in mPAP I C
>10mm of Hg to reach a value of mPAP <4010mm of Hg with a increased or unchanged CO.
Inhaled NO, iloprost or iv epoprostenol are recommended for performing Vasoreactivity testing . I C
Vasoreactivity testing , for identifying candidates for CCB therapy, is not recommended in PH III C
groups 2,3,4,5 and 1 except I/H/D PAH.