The pulmonary circulation in bronchopulmonary dysplasia

Abnormalities of the pulmonary circulation are increasingly being recognized as a major contributor to the high morbidity and mortality of bronchopulmonary dysplasia. Historically, studies have focused on the importance of pulmonary hypertension to the pathophysiology of BPD, with the assumption that pulmonary vascular abnormalities are a secondary consequence of primary injury to the airspace. Recent studies suggest, however, that abnormalities of the pulmonary vasculature, including altered growth and structure, may directly contribute to the abnormal alveolarization that characterizes the condition. In this article, we briefly outline mechanisms of pulmonary vascular injury in infants at risk of BPD. We then focus on the recognition and management of pulmonary hypertension in these infants. Finally, we review how disordered pulmonary vascular growth may contribute to the pathogenesis of BPD and emphasize the importance of the reciprocal development of the airspace and the pulmonary circulation.