Management of cardiac dysfunction in neonates with pulmonary hypertension and the role of the ductus arteriosus

Ruoss, J. Lauren; Moronta, Stephania Cavallaro; Bazacliu, Catalina; Giesinger, Regan E.

doi:10.1016/j.siny.2022.101368

Cited by 9 publications

(3 citation statements)

References 53 publications

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“…PPHN is a clinical neonatal critical illness with a relatively high incidence, which may occur in 1-2 per 1,000 newborns (37,38). PPHN has become a disease with high morbidity, mortality and disability (39,40). Impaired relaxation of the pulmonary vasculature in the early postnatal period leads to pulmonary circulatory resistance exceeding body circulatory resistance, resulting in severe hypoxemia and respiratory distress, and ultimately PPHN (3).…”

Section: Discussionmentioning

confidence: 99%

LncRNA H19 improves angiogenesis in mouse pulmonary artery endothelial cells by regulating the HIF-1α/VEGF signaling pathway

Dou,

You,

Chai

et al. 2024

Preprint

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Persistent pulmonary hypertension of the newborn (PPHN) is a syndrome of acute respiratory failure characterized by systemic hypoxemia and elevated pulmonary arterial pressure, which leads to pathological changes in pulmonary vascular remodeling and endothelial cell function. Long non-coding RNA (lncRNA) H19 has been shown to be involved in the regulation of arterial endothelial cell function, but its regulatory role in PHN is not fully understood. In the present study, mouse pulmonary artery endothelial cells (MPAECs) were cultured in a hypoxic environment. Subsequently, the regulatory function of lncRNA H19 on MPAECs was explored by constructing adenoviruses knocking down and overexpressing lncRNA H19. The results revealed that the hypoxic environment could induce the proliferation and migration of MPAECs, as well as the high expression of lncRNA H19 in MPAECs. Knockdown of lncRNA H19 expression in MPAECs reversed hypoxic environment-induced functional changes in endothelial cells, whereas overexpression of lncRNA H19 further enhanced the proliferation and migration of MPAECs. In addition, further assays revealed that lncRNA H19 upregulated the hypoxia-inducible factor-1α (HIF-1α)/vascular endothelial growth factor (VEGF) pathway through sponge adsorption of microRNA-20a-5p, which in turn promoted changes in endothelial cell function. LncRNA H19 may interfere with vascular remodeling in hypoxia-induced pulmonary hypertension by upregulating the expression of HIF-1α and VEGF in vascular endothelial cells.

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Section: Discussionmentioning

confidence: 99%

LncRNA H19 improves angiogenesis in mouse pulmonary artery endothelial cells by regulating the HIF-1α/VEGF signaling pathway

Dou,

You,

Chai

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

“…inhaled Nitric oxide - iNO) has been reported [ 11 , 12 ] in order to reduce pulmonary vascular resistance (PVR). On the contrary, in the setting of pulmonary venous hypertension, the literature suggests that the use of pulmonary vasodilators to decrease PVR can lead to clinical deterioration [ 13 ] due to a further increase in pulmonary flow with the potential for lung edema or hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

Use of levosimendan in hemodynamic management of heart failure in two neonates with intracranial arteriovenous shunts: a case series

Landolfo,

Giliberti,

De Rose

et al. 2023

Ital J Pediatr

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Background The hemodynamic status of newborns with intracranial arteriovenous shunts (AVSs) may be extremely complex. Mini-invasive hemodynamic monitoring through innovative techniques such as Near-Infrared Spectroscopy (NIRS) and Pressure Recording Analytical Method (PRAM) may help in understanding hemodynamics in newborns with AVSs. Levosimendan is a calcium sensitizer and inodilator, and it is known to improve ventricular function, but its use in newborns is limited. In our cases, we evaluated the effect of levosimendan on hemodynamics through NIRS and PRAM. Case presentation Herein, we report the cases of two neonates with intracranial arteriovenous shunts, in whom we used levosimendan to manage cardiac failure refractory to conventional treatment. Levosimendan was used at a dosage of 0.1 mcg/kg/min for 72 h. Combined use of NIRS and PRAM helped in real-time monitoring of hemodynamic effects; in particular, levosimendan determined significant improvement in myocardium contractility as well as a reduction of heart rate. Conclusion In two neonatal cases of AVSs, levosimendan led to an overall hemodynamic stabilization, documented by the combination of NIRS and PRAM. Our results suggest introducing levosimendan as a second-line treatment in cases of severe cardiac dysfunction due to AVSs without improvement using standard treatment strategies. Future prospective and larger studies are highly warranted.

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“…Many treatments, such as inhaled nitric oxide (iNO), inotropes, and extracorporeal life support (ECLS) provide support for right ventricle (RV) dysfunction 4 . Prostaglandin‐E1 (PGE) infusion to offload the RV via right‐to‐left shunting through a patent ductus arteriosus (PDA) is described as an adjunctive treatment, yet it is poorly explored 5,6 …”

Section: Introductionmentioning

confidence: 99%

Prostaglandin‐E1 infusion in persistent pulmonary hypertension of the newborn

Tsoi,

Nawaytou,

Almeneisi

et al. 2023

Pediatric Pulmonology

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BackgroundNeonates with persistent pulmonary hypertension of the newborn (PPHN) can present with hypoxia and right ventricular dysfunction with resultant inadequate oxygen delivery and end‐organ damage. This study describes the use of prostaglandin‐E1 (PGE) for ductal patency to preserve right ventricular systolic function and limit afterload in newborns with PPHN.MethodsThis is a retrospective cohort study that follows the hemodynamics, markers of end‐organ perfusion, length of therapeutics, and echocardiographic variables of 57 newborns who used prostglandin‐E1 in the setting of PPHN.ResultsTachycardia, lactic acidosis, and supplemental oxygen use improved following PGE initiation. Fractional area change (FAC), to assess right ventricular systolic function, and pulmonary arterial acceleration time indexed to right ventricular ejection time (PAAT/RVET), to assess right ventricular afterload, also improved over three time points relative to PGE use (before, during, and after).ConclusionsOverall, we described the safety and utility of PGE in newborns with severe PPHN for stabilization while allowing natural disease progression.

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Management of cardiac dysfunction in neonates with pulmonary hypertension and the role of the ductus arteriosus

Cited by 9 publications

References 53 publications

LncRNA H19 improves angiogenesis in mouse pulmonary artery endothelial cells by regulating the HIF-1α/VEGF signaling pathway

LncRNA H19 improves angiogenesis in mouse pulmonary artery endothelial cells by regulating the HIF-1α/VEGF signaling pathway

Use of levosimendan in hemodynamic management of heart failure in two neonates with intracranial arteriovenous shunts: a case series

Prostaglandin‐E1 infusion in persistent pulmonary hypertension of the newborn

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