Patent ductus arteriosus, bronchopulmonary dysplasia and pulmonary hypertension—a complex conundrum with many phenotypes?

El‐Khuffash, Afif; Mullaly, Rachel

doi:10.1038/s41390-023-02578-2

Cited by 4 publications

(8 citation statements)

References 8 publications

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“…As a result, an increasing number of preterm infants are and will be potentially exposed to a prolonged ductal shunt . As pointed out by El-Khuffash et al, it is unlikely that a true hsPDA with chronic left-to-right shunting does not play a role in pulmonary vascular remodeling during the first few weeks of life. Accordingly, the highest evidence for an association between PDA and BPD-PH came from the group of analyses that considered the duration of ductal shunting as a continuous or categorical variable (Figure 4).…”

Section: Discussionmentioning

confidence: 99%

“…With regard to exposure, a majority of the included studies were retrospective and did not report the time of diagnosis or treatment of PDA or the rate of response to treatment. In addition, the diagnostic criteria for hsPDA or the time limit defining prolonged exposure to PDA are the subject of ongoing and far from settled debate . It is important to note that the hemodynamic meaning of PDA is affected by factors such as the transductal diameter, the balance between pulmonary and systemic vascular resistance, and the compensatory capacity of the immature myocardium .…”

Section: Discussionmentioning

confidence: 99%

“…The studies included in the present meta-analysis used different combinations of these echocardiographic measurements (see eTable 2 in Supplement 1). However, none of these individual metrics is free from criticism regarding accuracy in the diagnosis of PH and limited ability to differentiate between high flow, elevated pulmonary vascular resistance (PVR), pulmonary venous hypertension from left ventricular diastolic dysfunction, or pulmonary vein stenosis as contributors of PH …”

Section: Discussionmentioning

confidence: 99%

“…However, none of these individual metrics is free from criticism regarding accuracy in the diagnosis of PH and limited ability to differentiate between high flow, elevated pulmonary vascular resistance (PVR), pulmonary venous hypertension from left ventricular diastolic dysfunction, or pulmonary vein stenosis as contributors of PH. 60,[85][86][87][88] The only study included in the meta-analysis that determined the presence of PH by cardiac catheterization was Philip et al 46 Although that study included a very selective group of infants, its findings are very relevant to differentiate the relative role of high flow vs high PVR in BPD-PH when a ductal shunt is present. They retrospectively analyzed a series of 100 infants with GA less than 27 weeks who underwent hemodynamic evaluation before transcatheter PDA closure.…”

Section: Limitationsmentioning

confidence: 99%

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Patent Ductus Arteriosus and Bronchopulmonary Dysplasia–Associated Pulmonary Hypertension

Villamor,

van Westering-Kroon,

Gonzalez-Luis

et al. 2023

JAMA Netw Open

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ImportanceBronchopulmonary dysplasia (BPD) is often associated with pulmonary vascular disease and secondary pulmonary hypertension (PH). The pathogenesis of BPD-associated PH (BPD-PH) is complex and involves prenatal and postnatal factors that disrupt pulmonary vascular development, and patent ductus arteriosus (PDA) is a factor potentially associated with risk of BPD-PH that has been identified in very recent studies.ObjectiveTo explore the association of PDA with BPD-PH using a bayesian model-averaged (BMA) meta-analysis of studies.Data SourcesPubMed and Embase were searched up to April 2023. Key search terms included BPD and PH.Study SelectionStudies examining infants with gestational age 32 weeks or less and reporting data on PDA and risk of BPD-PH.Data Extraction and SynthesisThis study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Meta-Analysis of Observational Studies in Epidemiology reporting guidelines. Two independent reviewers extracted data, with a third reviewer checking for accuracy and completeness. Data pooling and effect size calculations were performed by BMA.Main Outcomes and MeasuresThe primary outcome was BPD-PH. BMA was used to calculate Bayes factors (BFs). The BF10 is the ratio of the probability of the data under the alternative hypothesis (H1, association of PDA with BPD-HP) over the probability of the data under the null hypothesis (H0).ResultsA total of 32 studies (8513 infants) were included. BMA showed that the evidence in favor of H1 was weak for any PDA (BF10 = 2.90; 10 studies), moderate for hemodynamically significant PDA (BF10 = 3.77; 3 studies), and extreme for surgically ligated or catheter-occluded PDA (BF10 = 294.9; 16 studies). In contrast, the evidence in favor of H0 was weak for medically treated PDA (BF10 = 0.55; 6 studies). In addition, BMA found strong evidence in favor of H1 when prolonged exposure to PDA was analyzed as a dichotomous variable (BF10 = 11.80; 6 studies) and extreme evidence (BF10 = 113.60; 3 studies) when PDA exposure time was analyzed as a continuous variable.Conclusions and RelevanceIn this bayesian meta-analysis, the data suggest that prolonged exposure to PDA might be associated with increased risk of pulmonary vascular disease in extremely preterm infants. This highlights the need to monitor for PH in high-risk preterm infants with prolonged exposure to PDA and to incorporate PH risk into clinical decisions regarding PDA management.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

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Patent Ductus Arteriosus and Bronchopulmonary Dysplasia–Associated Pulmonary Hypertension

Villamor,

van Westering-Kroon,

Gonzalez-Luis

et al. 2023

JAMA Netw Open

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“…Hemodynamically significant shunts should hence be closed without delay in these patients. Standardization of the definition of hemodynamically significant PDA is however lacking ( 45 ).…”

Section: Pah-chdmentioning

confidence: 99%

Pulmonary vascular disease as a complication of pediatric congenital heart diseases

Wacker¹,

Joye²,

Genecand³

et al. 2023

Transl Pediatr

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Congenital and acquired heart diseases can cause pulmonary hypertension (PH) in children, either by increasing pulmonary blood flow (PBF), left atrial pressure (LAp), and/or pulmonary vascular resistance (PVR). Pathophysiological process of pulmonary vascular disease (PVD) in different types of congenital heart diseases (CHDs) are reviewed hereafter. As with other types of PH, a rigorous diagnostic evaluation is mandatory to characterize the etiology of the PH, rule out other or additional causes of PH, and establish a risk profile. Cardiac catheterization remains the gold standard exam for PH diagnosis. Treatment of pulmonary arterial hypertension (PAH) associated with CHD (PAH-CHD) can then be started according to the recent guidelines recommendations, although most of the evidence is extrapolated from studies on other causes of PAH. PH in pediatric heart disease is often multifactorial, and sometimes unclassifiable, making the management of these patients complicated. The operability of patients with a prevalent left-to-right shunt and increase of PVR, the management of children with PH associated with left-sided heart disease, the challenges of pulmonary vascular disorders in children with univentricular heart physiology and the role of vasodilator therapy in failing Fontan patients are some of the hot topics discussed in this review.

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Impact of Early Hemodynamic Screening on Extremely Preterm Outcomes in a High-Performance Center

Giesinger

Rios

Chatmethakul

et al. 2023

Am J Respir Crit Care Med

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Patent ductus arteriosus, bronchopulmonary dysplasia and pulmonary hypertension—a complex conundrum with many phenotypes?

Cited by 4 publications

References 8 publications

Patent Ductus Arteriosus and Bronchopulmonary Dysplasia–Associated Pulmonary Hypertension

Patent Ductus Arteriosus and Bronchopulmonary Dysplasia–Associated Pulmonary Hypertension

Pulmonary vascular disease as a complication of pediatric congenital heart diseases

Impact of Early Hemodynamic Screening on Extremely Preterm Outcomes in a High-Performance Center

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