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Pulmonary hypertension in infants with bronchopulmonary dysplasia
G Goodman1, R M Perkin, N G Anas
1Division of Critical Care, Children's Hospital of Orange County, CA 92668.
Insights
This study investigated pulmonary hypertension in children with bronchopulmonary dysplasia. Systemic-to-pulmonary collateral vessels impacted treatment response and prognosis, highlighting the need for advanced diagnostics.
Area of Science:
- Pediatric Cardiology
- Pulmonology
- Critical Care Medicine
Background:
- Bronchopulmonary dysplasia (BPD) is a chronic lung disease in infants, often leading to pulmonary hypertension (PH) and right ventricular hypertrophy (RVH).
- PH in BPD can be severe, impacting patient outcomes and requiring comprehensive evaluation.
- Systemic-to-pulmonary collateral vessels can complicate the management of PH in this population.
Purpose of the Study:
- To evaluate the hemodynamic responses to oxygen and hydralazine in children with PH complicating BPD.
- To investigate the role of systemic-to-pulmonary collateral vessels in the pathophysiology and treatment of PH in BPD.
- To assess the diagnostic, therapeutic, and prognostic value of cardiac catheterization in these patients.
Main Methods:
- Cardiac catheterization was performed on seventeen children with oxygen-dependent BPD, RVH, and PH.
- Hemodynamic parameters were assessed at baseline, with supplemental oxygen, and after hydralazine administration.
- Angiography was used to identify and characterize systemic-to-pulmonary collateral vessels.
Main Results:
- Fifteen patients had PH in room air; six had significant collateral vessels.
- Patients with collateral vessels showed adverse reactions to hydralazine, unlike some without collaterals.
- Five patients with persistent PH despite oxygen died, suggesting a poor prognosis in this subgroup.
Conclusions:
- Systemic-to-pulmonary collateral vessels are a critical factor influencing treatment response and outcomes in pediatric PH associated with BPD.
- Cardiac catheterization and angiography are essential tools for diagnosing, guiding therapy, and predicting prognosis in these complex cases.
- Early identification of collateral vessels may allow for more targeted and effective management strategies.
Abstract:
Seventeen children with oxygen-dependent bronchopulmonary dysplasia, right ventricular hypertrophy, and Doppler echocardiographic evidence of pulmonary hypertension were studied by cardiac catheterization. Fifteen of these patients had pulmonary hypertension when placed in room air; six of these 15 patients were shown to have large systemic-to-pulmonary collateral vessels. The hemodynamic responses to oxygen and hydralazine were evaluated. Five patients developed normal pulmonary artery pressure while receiving supplemental oxygen and were not studied further. Of the remaining ten patients, the six patients with large, hemodynamically significant collateral vessels all had deleterious reactions to hydralazine. Two of the four patients without collateral pulmonary circulation responded to hydralazine with further reductions in mean pulmonary artery pressure. Five of the ten patients who had persistent pulmonary hypertension while receiving oxygen have died. Cardiac catheterization and angiography may provide important diagnostic, therapeutic, and prognostic information in patients with pulmonary hypertension complicating bronchopulmonary dysplasia.