Inhaled Iloprost as a Rescue Therapy for Transposition of the Great Arteries With Persistent Pulmonary Hypertension of the Newborn

Ávila-Álvarez, Alejandro; Bravo-Laguna, Maria Carmen; Bronte, L. Deiros; Cerro, María Jesús del

doi:10.1007/s00246-012-0575-2

Cited by 19 publications

(37 citation statements)

References 12 publications

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“…[4][5][6][7] Postnatally, persistant pulmonary hypertension has been reported for some patients. 12,13 Recently, Punn et al 7 reported that hypermobile septum primum and retrograde diastolic flow in the ductus arteriosus can help predict the need for urgent atrioseptostomy. Neonates with transposition of the great arteries and intact ventricular septum need adequate interatrial mixing to reach an acceptable saturation.…”

Section: Discussionmentioning

confidence: 99%

Relationship between interatrial communication, ductus arteriosus, and pulmonary flow patterns in fetuses with transposition of the great arteries: prediction of neonatal desaturation

et al. 2017

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BackgroundThe relationship between interatrial communication, ductus arteriosus, and pulmonary flow in transposition of the great arteries and intact ventricular septum may help predict postnatal desaturation.MethodsEchocardiographic data of 45 fetuses with transposition of the great arteries and intact ventricular septum and 50 age-matched controls were retrospectively reviewed. Interatrial communication, left and right ventricular output, flow in the ductus arteriosus, as well as effective pulmonary flow were measured. Patients were divided into two groups on the basis of postnatal saturations: group 1 had saturations ⩽50% and group 2 >50%.ResultsOf 45 fetuses, 13 (26.7%) were classified into group 1. Compared with fetuses in group 2, they had a smaller interatrial communication (2.9 versus 4.0 mm, p=0.004) and more retrograde diastolic flow in the ductus arteriosus (92 versus 23%, p=0.002). Both groups showed a significant decrease in ductal flow compared with controls. Patients in group 2 had a higher effective pulmonary flow compared with controls. There was a mild correlation between left ventricular output and size of the interatrial communication (Spearman’s rank correlation 0.44).ConclusionA retrograde diastolic flow is present in most of the fetuses with postnatal desaturation. Fetuses with transposition of the great arteries have a lower flow through the ductus arteriosus compared with controls. Fetuses without restrictive foramen ovale have higher effective pulmonary flow. Peripheral pulmonary vasodilatation due to higher oxygen saturation in pulmonary arteries in the case of transposition of the great arteries could be one possible cause.

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Section: Discussionmentioning

confidence: 99%

Relationship between interatrial communication, ductus arteriosus, and pulmonary flow patterns in fetuses with transposition of the great arteries: prediction of neonatal desaturation

et al. 2017

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“…6,7 In recent years, individual case studies have demonstrated the efficacy of pulmonary vasodilators and extracorporeal membrane oxygenation (ECMO) in the treatment of PPHN in infants with D-TGA, both before and after ASO. 9,10 There is a paucity of data, however, on clinical correlates and short-term outcomes of infants with D-TGA who required inhaled nitric oxide (iNO) and/or ECMO. In the current study, we sought to determine the proportion of neonates with D-TGA who required iNO and/or ECMO at a single center and to compare their clinical characteristics and shortterm outcomes with others who did not require iNO and/or ECMO.…”

Section: -Loop Transposition Of the Great Arteries (D-mentioning

confidence: 99%

Persistent Pulmonary Hypertension of the Newborn with D-transposition of the Great Arteries: Management and Prognosis

Sallaam

Natarajan

Aggarwal

2015

Congenital Heart Disease

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“…Inability to wean PGE1 signifies unstable hemodynamics and, in our practice, triggers efforts to categorize the patient into the small subset of patients with TGA and reactive pulmonary vasculature. For these babies, increased awareness is warranted given the association with less a favorable perioperative course [26]. In fact, in our cohort, our only mortality was a patient with pulmonary hypertension after ASO whom we were unable to wean off mechanical circulatory support.…”

Section: Commentmentioning

confidence: 74%

Preoperative Intubation and Lack of Enteral Nutrition are Associated with Prolonged Stay After Arterial Switch Operation

et al. 2016

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Mortality for the arterial switch operation (ASO) has diminished significantly over the past few decades. Some patients do, however, continue to have protracted and complicated courses after surgery. We attempted to determine which preoperative factors were best associated with prolonged hospital stay after ASO. We retrospectively reviewed all patients that underwent an ASO over a 10-year period. Outcomes of patients with postoperative stays (POS) >14 days (long stay group-LS) were compared with those patients with POS < 7 days (short stay group-SS). The following variables were evaluated: age at surgery, weight, septostomy performed (BAS) and management the day prior to surgery including use of prostaglandin E1 (PGE1), inotropes, intubation status and the establishment of enteral feeds. The SS group had 25 patients and the LS group had 32 patients. Both groups (SS vs. LS) were similar in PGE1 use (48 vs. 69 %), BAS (76 vs. 59 %), age at surgery (6 vs. 7 days) and preoperative inotropes (12 vs. 38 %). The SS group had significantly higher incidence of preoperative feeding (80 vs. 31 %, p < 0.001) and less frequent intubation (12 vs. 47 %, p < 0.001). Patients who are intubated and have not yet begun to receive enteral feeds at the time of their ASO are more likely to have prolonged POS. It is unclear if prolonged stays were a result of operating on patients with worse preoperative hemodynamics or a consequence of a preoperative management strategy that did not allow for extubation and establishment of feeds prior to surgery.

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Inhaled Iloprost as a Rescue Therapy for Transposition of the Great Arteries With Persistent Pulmonary Hypertension of the Newborn

Cited by 19 publications

References 12 publications

Relationship between interatrial communication, ductus arteriosus, and pulmonary flow patterns in fetuses with transposition of the great arteries: prediction of neonatal desaturation

Relationship between interatrial communication, ductus arteriosus, and pulmonary flow patterns in fetuses with transposition of the great arteries: prediction of neonatal desaturation

Persistent Pulmonary Hypertension of the Newborn with D-transposition of the Great Arteries: Management and Prognosis

Preoperative Intubation and Lack of Enteral Nutrition are Associated with Prolonged Stay After Arterial Switch Operation

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