Use of prostaglandin E1 to treat pulmonary hypertension in congenital diaphragmatic hernia

Lawrence, Kendall M.; Berger, Kelsey; Herkert, Lisa M.; Franciscovich, Christine D.; O'Dea, Carol Lynn; Waqar, Lindsay N.; Partridge, Emily A.; Hanna, Brian D.; Peranteau, William H.; Avitabile, Catherine M.; Hopper, Rachel K.; Rintoul, Natalie E.; Hedrick, Holly L.

doi:10.1016/j.jpedsurg.2018.10.039

Cited by 43 publications

(38 citation statements)

References 46 publications

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“…Prostaglandin E1 was well tolerated in patients with CDH and severe PAH. 7 With aggressive PAH therapies, this patient had a favorable outcome despite having an estimated fetal MRI-calculated O/E total lung volume of 25%; reported survival with an O/E <25% is 13%. 8 In this case, PGE1 was used to create a "reverse Potts shunt" to decompress the RV, to successfully support a newborn with severe intractable PAH secondary to CDH.…”

Section: Commentsmentioning

confidence: 85%

Combination of PGE1 and Pulmonary Vasodilator Therapy in Managing a Challenging Case of Severe PAH Secondary to CDH

Aljohani

Rao

Mackie

et al. 2020

World J Pediatr Congenit Heart Surg

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Congenital diaphragmatic hernia (CDH) is a rare disease, which affects 1 in 2,500 newborns. Congenital diaphragmatic hernia can interfere with the normal development of the pulmonary parenchyma and vascular bed, and in severe cases, it can lead to the development of severe pulmonary arterial hypertension (PAH) and right ventricular failure. We present a neonate with CDH who developed severe PAH and right ventricular dysfunction and was managed with a unique strategy combining venoarterial extracorporeal membrane oxygenation, prostaglandin E1, and a variety of PAH therapies.

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Section: Commentsmentioning

confidence: 85%

Combination of PGE1 and Pulmonary Vasodilator Therapy in Managing a Challenging Case of Severe PAH Secondary to CDH

Aljohani

Rao

Mackie

et al. 2020

World J Pediatr Congenit Heart Surg

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“…Additionally, ECMO utilization (67% vs. 48%, P=0.0024), and mortality (17% vs. 29%, P=0.04) were both decreased compared to non-iNO responders. Finally, a retrospective study of a single institution with 73% of CDH neonates treated with iNO for severe pulmonary hypertension reported a 40% response rate in those with preserved left ventricular systolic function (66). Response was defined by improvements in PaO 2 levels of greater than 20mmHg and subsequent improvements in alveolararterial gradients and PaO 2 /FiO 2 ratios (both P<0.01).…”

Section: Management Of Pulmonary Hypertensionmentioning

confidence: 99%

“…In contrast to non-responders, they reported a decreased need for ECMO (24% vs. 50%, P=0.02). These investigators concluded that iNO treatment may be beneficial in a subset of CDH neonates with normal left ventricular systolic function and pulmonary hypertension (66). As iNO use can lead to increased pulmonary venous return, this might precipitate cardiopulmonary failure in a left ventricle that is compromised in size and/or function.…”

Section: Management Of Pulmonary Hypertensionmentioning

confidence: 99%

Congenital diaphragmatic hernia: a narrative review of controversies in neonatal management

Yang¹,

Russell²,

Yoder³

et al. 2021

Transl Pediatr

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A congenital diaphragmatic hernia (CDH) results from the inadequate formation of the diaphragm during embryogenesis and causes a cascade of events which can present in a newborn child varying clinically from mild to very severe to fatal. The incidence of CDH is 1 in 2,500 to 1 in 3,500 live births and occurs 90% of the time in the posterolateral aspect of the diaphragm known as a Bochdalek hernia with over 85% occurring on the left side (1). The diaphragmatic defect in the embryo allows for abdominal viscera to enter the thoracic cavity causing a mass effect on the developing lungs resulting in pulmonary hypoplasia and pulmonary hypertension. The degree of clinical severity is often proportional to the size of the defect (Figure 1) (2,3). Although the consequences of other hernias can be avoided when repaired surgically, often there is no quick fix to this underlying dysgenesis of the lungs. In fact, past review of immediate repair demonstrated a worsening in the physiology of CDH neonates, which helped shift repair to a more delayed approach (4). These issues are most often addressed through medical management Review Article on Fetal Surgery

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“…However, the capability of the seaweed in producing prostaglandin need to be calculated in order to use the seaweed in producing prostaglandin in vitro for pharmaceutical and clinical applications. Prostaglandin compounds commonly applicated in human and animal reproduction (Bartlewski & Candappa, 2015) but also used in handling disease in livestock (Caldas, Freitas, Azevedo, & de Souza, 2018) and human health (Lawrence et al, 2018;Lee, Choe, Heo, & Je ong, 2018).…”

Section: Introductionmentioning

confidence: 99%

The capability of the red seaweed Gracilaria vermiculophylla in producing prostaglandins

Illijas¹,

Nasir²,

Dahlia³

et al. 2019

Preprint

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The red seaweed G. vermiculophylla is rich in polyunsaturated fatty acids with 20 carbon atoms, mainly arachidonic acid (AA) and eicosapentaenoic acid, which are precursors of prostaglandins (PGs). The present study aimed to elucidate the capability of the seaweed in releasing PGs using acetone powder as the crude enzyme. Crude enzyme was prepared using cold acetone. The crude enzyme was incubated with AA at different concentrations (0.1– 4 mg). For determination of PG contents, 5 µL of sample as the test solution corresponding to 0.2 g wet mass of the seaweed was injected into the HPLC. For mass spectrometer analysis, an HPLC system connected with mass spectrometer was used. Results of the study showed that t he released PGs from incubation of acetone powder and AA analyzed by HPLC consisted of PGE 2 , 15-keto-PGE 2 , 15-hydroperoxy-PGE 2 , PGA 2 , and AA while PGs detected by LC-MS were PGF 2α , PGE 2 , 15-keto-PGE 2 , 15-hydroperoxy-PGE 2 , and PGA 2 . The capability of the red algae in producing PGs was affected by available oxygen, aspirin, a cyclooxygenase inhibitor, and AA concentration. The crude enzyme of the red alga (250 mg) was capable to produce 1.63 µg and 1.32 µg of PG 2 and 15-keto-PGE 2 from incubation with 0.25 mg of AA. This method could be the one way to provide PGs in vitro to fulfill demands of PGs in the pharmaceutical industry.

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Use of prostaglandin E1 to treat pulmonary hypertension in congenital diaphragmatic hernia

Cited by 43 publications

References 46 publications

Combination of PGE1 and Pulmonary Vasodilator Therapy in Managing a Challenging Case of Severe PAH Secondary to CDH

Combination of PGE1 and Pulmonary Vasodilator Therapy in Managing a Challenging Case of Severe PAH Secondary to CDH

Congenital diaphragmatic hernia: a narrative review of controversies in neonatal management

The capability of the red seaweed Gracilaria vermiculophylla in producing prostaglandins

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