Right ventricular echocardiographic indices predict poor outcomes in infants with persistent pulmonary hypertension of the newborn

Malowitz, Jonathan R.; Forsha, Daniel; Smith, P. Brian; Cotten, C. Michael; Barker, Piers; Tatum, Gregory H.

doi:10.1093/ehjci/jev071

Cited by 49 publications

(36 citation statements)

References 34 publications

(44 reference statements)

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“…These findings may reflect the response of the right ventricular myocardium to increased afterload in cases of elevated pulmonary artery pressure. 33 Our results are in agreement with the study of McCrary et al who have shown the ratio of systole over diastole duration to be higher in chronic lung disease patients with pulmonary hypertension than those without. 15 The fact that echo parameters of right ventricular performance improved quickly post-opertively in our pulmonary hypertension infants may indicate the contribution of a significant atrial shunt to elevated pulmonary artery pressure and impaired right ventricular contractility.…”

Section: Early Atrial Septal Defect Repair and Right Ventricular Perfsupporting

confidence: 94%

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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Section: Early Atrial Septal Defect Repair and Right Ventricular Perfsupporting

confidence: 94%

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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“…There is limited data specific to the impact of PVR on preterm myocardial function, though a similar decline in RV performance as in term neonates is reported (25). An understanding of the impact of PVR on the myocardium is important because it may significantly modify disease pathophysiology and in term neonates may be a predictor of poor outcome (26). Fetal myocardial performance remains stable over the latter half of pregnancy (27,28), and animal data suggest that changes in loading conditions produce similar changes in contractility across gestations.…”

Section: Implications Of High Pvr On Myocardial Functionmentioning

confidence: 99%

Controversies in the identification and management of acute pulmonary hypertension in preterm neonates

Giesinger

Odame

et al. 2017

Pediatr Res

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It is increasingly recognized that the abnormal physiologic consequences of pulmonary hypertension (PH) may contribute to poor cardiopulmonary health in premature babies. Conflicting literature has led to clinical uncertainty, pathological misinterpretation, and variability in treatment approaches among practitioners. There are several disorders with overlapping and interrelated presentations, and other disorders with a similar clinical phenotype but diverse pathophysiological contributors. In this review, we provide a diagnostic approach for acute hypoxemic respiratory failure in the preterm neonate, outline the pathophysiological conditions that may present as acute PH, and discuss the implications of high pulmonary vascular resistance (PVR) on the cardiovascular system. Although PVR and respiratory management are highly interrelated, there may be a population of preterm neonates in whom inhaled nitric oxide may improve illness severity and may relate to outcomes. A management approach based on physiology that considers common clinical conundrums is provided. A more comprehensive understanding of the physiology may help in informed decision-making in clinical situations where conclusive scientific evidence is lacking. Regardless, high-quality research is required, and appropriate definition of the target population is paramount. A thoughtful approach to cardiovascular therapy may also provide an avenue to improve neurodevelopmental outcomes while awaiting more clear answers.

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“…These methods include: RV systolic tissue Doppler velocity (RV s′), tissue Doppler-derived basal longitudinal strain (RV BLS); tricuspid annular plane systolic excursion (TAPSE) and fractional area change (FAC). Recent evidence suggests that those parameters can determine disease severity and predict adverse outcomes in term infants with pulmonary hypertension 9. However, their applicability in the clinical setting, the influence of various physiological states and the interaction between left ventricle (LV) and RV function in preterm infants has not been adequately studied.…”

Section: Introductionmentioning

confidence: 99%

The impact of a hyperdynamic left ventricle on right ventricular function measurements in preterm infants with a patent ductus arteriosus

Breatnach

Franklin

James

et al. 2017

Arch Dis Child Fetal Neonatal Ed

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Right ventricular echocardiographic indices predict poor outcomes in infants with persistent pulmonary hypertension of the newborn

Cited by 49 publications

References 34 publications

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

Controversies in the identification and management of acute pulmonary hypertension in preterm neonates

The impact of a hyperdynamic left ventricle on right ventricular function measurements in preterm infants with a patent ductus arteriosus

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