Anatomical Closure of Left-to-Right Shunts in Premature Infants with Bronchopulmonary Dysplasia and Pulmonary Hypertension: A Cautionary Tale

Dereddy, Narendra; Chilakala, Sandeep; Rana, Divya

doi:10.1055/s-0035-1548543

Cited by 2 publications

(1 citation statement)

References 14 publications

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“…Case reports suggest that pulmonary hypertensive crises may result in right ventricular failure in patients with supra-systemic pulmonary pressures who have PDA ligation or pharmacological closure as a pulmonary-to-systemic shunt through a PDA could serve to relieve pulmonary pressures. [ 28 , 29 ] Additionally, the use of supplemental oxygen for the management of PH and BPD may have competing effects with respect to pulmonary blood flow as increased arterial oxygen saturation may lead to ductal constriction reducing blood flow, but also pulmonary vasodilation increasing blood flow. [ 30 ] It is unknown whether any of the pharmacological agents used for the management of PH (e.g., sildenafil, bosentan, etc.)…”

Section: Discussionmentioning

confidence: 99%

Risk Factors and Clinical Outcomes in Preterm Infants with Pulmonary Hypertension

Collaco¹,

Dadlani²,

Nies³

et al. 2016

PLoS ONE

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BackgroundPulmonary hypertension (PH) is a significant cause of morbidity in preterm infants, but no screening guidelines exist. We sought to identify risk factors and clinical outcomes associated with PH in preterm infants to develop a PH risk score.MethodsRetrospective analysis of two separate populations of preterm infants (NICU cohort n = 230; Clinic registry n = 580).Results8.3% of the NICU cohort had PH after 4 weeks of age, while 14.8% of the clinic registry had PH after 2 months of age. Lower birth weights and longer initial hospitalizations were associated with PH in both populations (p<0.001 for all tests). Using adjusted logistic regression, patent ductus arteriosus (PDA) requiring ligation was associated with PH in both the NICU cohort (OR: 3.19; p = 0.024) and the clinic registry (OR: 2.67; p<0.001). Risk factors (birth weight ≤780 grams, home supplemental oxygen use, and PDA ligation) identified in the clinic registry (training dataset) were validated in the NICU cohort with 0–1 factors present were associated with ≤1.5% probability of having PH, any 2 factors with a 25% probability, and all 3 factors with a 40% probability.ConclusionsLower birth weight, PDA ligation, and respiratory support were associated with PH in both populations. A PH risk score based on clinical indicators from the training dataset predicted PH in the validation set. This risk score could help focus resources to preterm infants at higher risk for PH. Further work is needed to determine whether earlier or more aggressive management of ductal lesions could alter PH outcomes.

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Section: Discussionmentioning

confidence: 99%

Risk Factors and Clinical Outcomes in Preterm Infants with Pulmonary Hypertension

Collaco¹,

Dadlani²,

Nies³

et al. 2016

PLoS ONE

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Repair of isolated atrial septal defect in infants less than 12 months improves symptoms of chronic lung disease or shunt-related pulmonary hypertension

et al. 2020

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Introduction:Infants with isolated atrial septal defects are usually minimally symptomatic, and repair is typically performed after infancy. Early repair may be considered if there is high pulmonary blood flow and reduced respiratory reserve or early signs of pulmonary hypertension. Our aim was to review the characteristics and outcomes of a cohort of patients who underwent infant repair at our institute.Methods:The study included 56 infants (28 female, 19 trisomy 21) with isolated atrial septal defect (age: 8 months (1.5–12), weight: 6 kg (2.8–7.5), echo Qp/Qs: 1.9 ± 0.1) who underwent surgical closure (20 fenestrated). Three groups were identified: 1) chronic lung disease and pulmonary hypertension (group A: n = 28%); 2) acutely unwell infants with pulmonary hypertension but no chronic lung disease (group B: n = 20, 36%); and 3) infants with refractory congestive heart failure without either pulmonary hypertension or chronic lung disease (group C: n = 9, 16%).Results:Post-operatively, pulmonary hypertension infants (47/56) showed improvement in tricuspid annular plane systolic excursion z-score (p < 0.001) and right ventricular systolic/diastolic duration ratio (p < 0.05). All ventilator (14.3%) or oxygen-dependent (31.6%) infants could be weaned within 2 weeks after repair. One year later, weight z-score increased in all patients and by +1 in group A, +1.3 in group B and +2 in group C. Over a median follow-up of 1.4 years, three patients died, four patients continued to have pulmonary hypertension evidence and two remained on targeted pulmonary hypertension therapy.Conclusion:Atrial septal defect repair within the first year may improve the clinical status and growth in infants with early signs of pulmonary hypertension or those requiring respiratory support and facilitate respiratory management.

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Anatomical Closure of Left-to-Right Shunts in Premature Infants with Bronchopulmonary Dysplasia and Pulmonary Hypertension: A Cautionary Tale

Cited by 2 publications

References 14 publications

Risk Factors and Clinical Outcomes in Preterm Infants with Pulmonary Hypertension

Risk Factors and Clinical Outcomes in Preterm Infants with Pulmonary Hypertension

Repair of isolated atrial septal defect in infants less than 12 months improves symptoms of chronic lung disease or shunt-related pulmonary hypertension

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