Assessing pulmonary circulation in severe bronchopulmonary dysplasia using functional echocardiography

Sehgal, Arvind; Blank, Douglas A; Roberts, Calum T.; Menahem, Samuel; Hooper, Stuart B.

doi:10.14814/phy2.14690

Cited by 6 publications

(2 citation statements)

References 58 publications

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“…Persistent evidence of PAH, despite iNO response and decreased oxygen requirements, may suggest reduced intrapulmonary shunt and improved VQ matching with incomplete resolution of the high pulmonary vascular resistance state. This finding is supported by the lack of statistical differences between TAPSE Z-Scores and TPV:RVET, both considered surrogates of pulmonary vascular resistance [44].…”

Section: Discussionmentioning

confidence: 96%

Echocardiographic Assessment of Pulmonary Arterial Hypertension Following Inhaled Nitric Oxide in Infants with Severe Bronchopulmonary Dysplasia

et al. 2023

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Objectives: Inhaled nitric oxide (iNO) is an effective pulmonary vasodilator. However, the efficacy of iNO in former premature infants with established bronchopulmonary dysplasia (BPD) has not been studied. This study aimed to determine the efficacy of iNO in reducing pulmonary artery pressure in infants with severe BPD as measured by echocardiography. Study Design: Prospective, observational study enrolling infants born at less than 32 weeks gestation and in whom (1) iNO therapy was initiated after admission to our institution, or (2) at the outside institution less than 48 h before transfer and received an echocardiogram prior to iNO initiation, and (3) had severe BPD. Data were collected at three time-points: (1) before iNO; (2) 12–48 h after initiation of iNO; and (3) 48–168 h after initiation of iNO. The primary outcome was the effect of iNO on pulmonary artery pressure measured by echocardiography in patients with severe BPD between 48 and 168 h after initiating iNO therapy. Results: Of 37 enrolled, 81% had echocardiographic evidence of pulmonary arterial hypertension (PAH) before iNO and 56% after 48 h of iNO (p = 0.04). FiO2 requirements were significantly different between time-points (1) and (3) (p = 0.05). There were no significant differences between Tricuspid Annular Plane Systolic Excursion (TAPSE) Z-Scores, time to peak velocity: right ventricular ejection time (TPV:RVET), and ventilator changes. Conclusions: Although we found a statistically significant reduction of PAH between time-point (1) and (3), future trials are needed to further guide clinical care.

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Section: Discussionmentioning

confidence: 96%

Echocardiographic Assessment of Pulmonary Arterial Hypertension Following Inhaled Nitric Oxide in Infants with Severe Bronchopulmonary Dysplasia

et al. 2023

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“…In patients ≤ 1 year of age, some of which were preterm with BPD and/or patent ductus arteriosus (PDA), infant PAT was inversely related to mPAP, systolic PAP, and PVR 5 . Interestingly, when BPD-PH patients received either 100% O 2 or 20ppm nitric oxide, PATET lengthened, indicative of improved PAP 34 .…”

Section: Preterm Infant Pat and Patetmentioning

confidence: 98%

PATET ratio by Doppler echocardiography: noninvasive detection of pediatric pulmonary arterial hypertension

et al. 2021

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Pulmonary artery acceleration time (PAT) and PAT: ejection time (PATET) ratio are echocardiographic measurements of pulmonary arterial hypertension (PAH). These non-invasive quantitative measurements are ideal to follow longitudinally through the clinical course of PAH, especially as it relates to need for and/or response to treatment. This review article focuses on the current literature of PATET measurement for infants and children as it relates to shortening of the PATET ratio in PAH. At the same time, further development of PATET as an outcome measure for PAH in pre-clinical models, particularly mice, such that the field can move forward to human clinical studies that are both safe and effective. Here we present what is known about PATET in infants and children and discuss what is known in pre-clinical models with particular emphasis on neonatal mouse models. In both animal models and human disease, PATET allows for longitudinal measurements in the same individual, leading to more precise determinations of disease/model progression and/or response to therapy.

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Inhaled nitric oxide use in newborns

Mitra

Altit

2023

Paediatrics &Amp; Child Health

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Inhaled nitric oxide (iNO), a selective pulmonary vasodilator, is used as a therapeutic modality in infants with hypoxemic respiratory failure (HRF) associated with persistent pulmonary hypertension of the newborn (PPHN). iNO should ideally be initiated following echocardiographic confirmation of PPHN. Use of iNO is recommended in late preterm and term infants who develop HRF despite optimal oxygenation and ventilation strategies. However, routine iNO use in preterm infants on respiratory support is not recommended. iNO may be considered as a rescue modality in preterm infants with early-onset HRF when associated with prolonged rupture of membranes or oligohydramnios, or late-onset HRF in the context of bronchopulmonary dysplasia-associated pulmonary hypertension (PH) with severe right ventricular failure. A trial of iNO may also be considered for infants with congenital diaphragmatic hernia with persistent HRF despite optimal lung recruitment, and with echocardiographic evidence of supra-systemic PH and adequate left ventricular function.

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Assessing pulmonary circulation in severe bronchopulmonary dysplasia using functional echocardiography

Cited by 6 publications

References 58 publications

Echocardiographic Assessment of Pulmonary Arterial Hypertension Following Inhaled Nitric Oxide in Infants with Severe Bronchopulmonary Dysplasia

Echocardiographic Assessment of Pulmonary Arterial Hypertension Following Inhaled Nitric Oxide in Infants with Severe Bronchopulmonary Dysplasia

PATET ratio by Doppler echocardiography: noninvasive detection of pediatric pulmonary arterial hypertension

Inhaled nitric oxide use in newborns

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