In Reply to: Re: Case 0400_04 -- The Safety of Pulmonary Angiography in Patients with Severe Pulmonary Hypertension posted by Grant Price on April 07, 2000 at 09:00:14:
Many of the "contraindications" no longer apply (or are at least relative rather than absolute) with the advances in contrast and catheter technology. Small series have been reported suggesting that the pressure "cut offs" should be higher or not applied at all.
I've performed PA grams in the setting of pulmonary hypertension without adverse outcome except in one case. In that case, a previously healthy young woman developed profound pulmonary hypertension following the delivery of her second child. Her PA pressures were equal to systemic. A nonselective left PA test injection with 5 cc of half strength nonionic dye opacified the entire pulmonary artery and was follwed by acute right heart failure. She did not survive.
It's probably best to differentiate patient's clinically as either compensated or uncompensated (chronic vs acute +/- superimposed acute) pulmonary hypertensives rather than by strict pressure criteria. In the uncompensated state, I reduce my injection volumes and suplement with superselective injections as needed.