The respiratory system in pediatric chronic heart disease

Abstract

Cardiovascular disease in the pediatric population closely affects the respiratory system inducing water retention in the lungs and pulmonary edema, airway compression by cardiovascular structures, restrictive pulmonary physiology as a result of hemodynamic changes and surgical repair, susceptibility to respiratory infections, development of pulmonary hypertension, thrombosis, or hemorrhage. Chronic heart failure and congenital heart disease are characterized by various respiratory manifestations and symptoms mimicking lung disease, which are frequently difficult to diagnose and treat. Pulmonary function is multiply affected in pediatric heart disease with mostly restrictive but also obstructive and diffusion abnormalities. Patients with Fontan circulation represent a separate group with slow, passive pulmonary blood flow and distinct pathophysiology with low cardiac output heart failure, restrictive lung pattern, increased thromboembolic complications and rare conditions such as protein losing enteropathy and plastic bronchitis. Distinguishing between cardiovascular and pulmonary symptoms may be challenging in the growing population of pediatric and adult survivors of congenital heart disease and understanding of the relationship of the two systems in heart disease is crucial for the optimal management of these patients.

Feasibility of lung ultrasound to assess pulmonary overflow in congenital heart disease children

“…Besides, the unique features of infant pulmonary physiology and relatively immature lung structure, including the thinner trachea and bronchial tubes, thinner mucosa, richer blood supply, and lesser elastic tissue in the lungs, may place infants at a higher risk for PO . Pulmonary edema is one of the main concerns in fluid therapy . This may suggest that the lung and respiratory condition of infants with CHD should be of concern during intraoperative rehydration.…”

“…26 Pulmonary edema is one of the main concerns in fluid therapy. 2 This may suggest that the lung and respiratory condition of infants with CHD should be of concern during intraoperative rehydration.…”

“…Both lung diseases and congenital heart lesions contribute to its occurrence. PO affects the lung mechanics and gas‐exchange, as well as the function and pathophysiology of the circulatory system in children with congenital heart disease (CHD) . Pulmonary overcirculation may result in death before or after surgery if not corrected .…”

Pediatric Pulmonology Year in Review 2018: Rare lung disease, neuromuscular disease, and diagnostic testing

“…It is thought to be the result of abnormal lymphatic flow through the lungs. Pediatric PB most often occurs in congenital heart disease (CHD) patients with single‐ventricle physiology and is associated with high mortality . Management involves attempting to correct the underlying condition and facilitating cast removal, sometimes by bronchoscopy.…”

“…Pediatric PB most often occurs in congenital heart disease (CHD) patients with single-ventricle physiology and is associated with high mortality. 1 Management involves attempting to correct the underlying condition and facilitating cast removal, sometimes by bronchoscopy. Percutaneous lymphatic intervention (PCL) is a procedure that attempts to interrupt abnormal pulmonary lymphatic perfusion through embolization of the thoracic duct.…”