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Original Research: PULMONARY VASCULAR DISEASE |

Effect of Balloon Inflation Volume on Pulmonary Artery Occlusion Pressure in Patients With and Without Pulmonary Hypertension

Adriano R. Tonelli, MD; Kamal K. Mubarak, MD, FCCP; Ning Li, PhD; Robin Carrie, ARNP; Hassan Alnuaimat, MD
Author and Funding Information

From the Pulmonary Vascular Disease Program (Drs Tonelli, Mubarak, and Alnuaimat and Ms Carrie), Division of Pulmonary and Critical Care, Department of Medicine, and Department of Epidemiology and Biostatistics (Dr Li), University of Florida, Gainesville, FL.

Correspondence to: Adriano R. Tonelli, MD, Health Science Center, PO Box 100225, 1600 SW Archer Rd, Rm M452, Gainesville, FL 32610-0225; e-mail: Adriano.Tonelli@medicine.ufl.edu


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(1):115-121. doi:10.1378/chest.10-0981
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Background:  Pulmonary artery occlusion pressure (PAOP) is used to differentiate patients with pulmonary hypertension (PH) associated with left-sided heart disease from other etiologies. Technical errors in the measurement of PAOP are common and lead to incorrect classification of the etiology of PH. We investigated the agreement among PAOP measurements obtained from both pulmonary arteries with balloon full (1.5 mL) and half (0.75 mL) inflation in patients undergoing right-sided heart catheterization for suspected PH.

Methods:  Thirty-seven patients suspected or known to have PH who underwent right-sided heart catheterization were included. Seventy-six percent had PH (mean pulmonary arterial pressure > 25 mm Hg). The validity of the measurements was assessed by using five preestablished criteria based on hemodynamic, fluoroscopic, and gasometric data. For each patient, the measurement that most likely represented the left atrial pressure was labeled “best PAOP.”

Results:  Seventy percent of all the PAOP measurements met at least four of the five preestablished criteria for validity. In patients with PH (n = 28), the mean ± SE PAOP was 23.1 ± 2 and 19.1 ± 2 mm Hg for balloon full and half inflation, respectively, in the right pulmonary artery and 23.54 ± 2 and 19.07 ± 2 mm Hg for balloon full and half inflation, respectively, in the left pulmonary artery (P = .05). Bland-Altman analysis revealed lower bias and narrower limits of agreement with balloon half inflation. Wedge angiography showed that some balloon inflations failed to occlude upstream flow, whereas others had collateral vessels draining after the occlusion.

Conclusions:  PAOP can be falsely elevated in patients with PH according to the balloon inflation volume. Balloon half inflation was safe and correlated with higher precision and lower bias in the PAOP measurements.

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