Cardiovascular impact and sequelae of bronchopulmonary dysplasia

Abstract

The development, growth, and function of the cardiac, pulmonary, and vascular systems are closely intertwined during both fetal and postnatal life. In utero, placental, environmental, and genetic insults may contribute to abnormal pulmonary alveolarization and vascularization that increase susceptibility to the development of bronchopulmonary dysplasia (BPD) in preterm infants. However, the shared milieu of stressors may also contribute to abnormal cardiac or vascular development in the fetus and neonate, leading to the potential for cardiovascular dysfunction. Further, cardiac or pulmonary maladaptation can potentiate dysfunction in the other organ, amplify the risk for BPD in the neonate, and increase the trajectory for overall neonatal morbidity. Beyond infancy, there is an increased risk for systemic and pulmonary vascular disease including hypertension, as well as potential cardiac dysfunction, particularly within the right ventricle. This review will focus on the cardiovascular antecedents of BPD in the fetus, cardiovascular consequences of preterm birth in the neonate including associations with BPD, and cardiovascular impact of prematurity and BPD throughout the lifespan.

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“…41,42 Associated with this finding is the observation that hypoxemia itself may be a predictor of PH in ILD. 38,39 As mentioned earlier, patients with PH-ILD have decreased exercise tolerance as measured by 6MWD. 34 Though 6MWD is not routinely part of the ILD follow-up protocols, when performed, a decrease in exercise capacity, particularly if not associated with progression of the underlying ILD, can be a signal of progression of pulmonary vascular disease.…”

“…4,9 On the other hand, multiple studies have demonstrated that low DLCO is a predictor of the presence of PH in ILD. 9,31,[37][38][39] Steen and colleagues observed that an FVC:DLCO ratio of >1.4 was an excellent predictor of development of isolated PAH. 40 Seibold reported that an FVC:DLCO ratio of ≥1.8 was a good predictor of death in SSc, while Trad and colleagues found a ratio of ≥2 to predict survival.…”

“…Serial magnetic resonance imaging machines have the advantage of demonstrating longitudinal and circumferential RV strain, PA stiffness, and reduced RV and PA coupling. 38 Echocardiography: The 2015 European Society of Cardiology/European Respiratory Society (ESC/ERS) guidelines for the diagnosis and treatment of PH recommend screening patients with suspicion for PH using a transthoracic echocardiogram. These guidelines recommend yearly echocardiographic screening for all patients with SSc.…”

PH Professional Network: 360-degree Care for the Bronchopulmonary Dysplasia Infant with Pulmonary Hypertension: A Comprehensive Review

“…37 For these reasons, careful consideration for right heart catheterization may still be considered for the diagnosis of PH, while also allowing interrogation of important potential cardiac comorbidities. 38 The echocardiogram must be reviewed carefully to exclude other causes of elevated right ventricular pressure, such as left heart disease, PVS, left-to-right shunts, and intrinsic cardiac conditions. A direct estimate of the systolic function of the right ventricle (RV) may not be possible because of inadequate tricuspid jet velocity.…”

A scoping review of echocardiographic and lung ultrasound biomarkers of bronchopulmonary dysplasia in preterm infants

“…In the pre-surfactant era, the BPD is predominately resulted from VILI leading to marked regional inflammation. The current "new" BPD features are primarily characterized by abnormally reduced number and structurally simplified alveoli, and by dysmorphic pulmonary arteries (2,3).…”