Right Ventricular Function in Infants with Bronchopulmonary Dysplasia: Association with Respiratory Sequelae

Sehgal, Arvind; Malikiwi, Andra; Paul, Eldho; Tan, Kenneth; Menahem, Samuel

doi:10.1159/000442967

Cited by 42 publications

(39 citation statements)

References 26 publications

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“…A recent prospective study using vascular ultrasound noted increased arterial (aorta) wall thickness and stiffness in this population (Sehgal et al. ,b,c). Its effects on the hypertrophy of the heart and reduced function consequent to increased afterload, and its likely contribution to BPD pathophysiology by way of pulmonary venous congestion has also been commented on in premature infants with BPD (Mourani et al.…”

Section: Introductionmentioning

confidence: 76%

“… and Sehgal et al. ,b,c). This previously published model, summarized in Figure , focused on the adjunctive role of back pressure changes from the altered systemic vasculature; LV hypertrophy, diastolic dysfunction, and raised LV end‐diastolic pressure, mediate this constellation of events (Sehgal et al.…”

Section: Introductionmentioning

confidence: 90%

“…In a paradigm shift, investigators have recently focused on left‐sided cardiac and vascular changes which may be relevant to the pathogenesis and possible treatment of BPD (Sehgal et al. ,b,c). A recent prospective study using vascular ultrasound noted increased arterial (aorta) wall thickness and stiffness in this population (Sehgal et al.…”

Section: Introductionmentioning

confidence: 99%

“…This previously published model, summarized in Figure , focused on the adjunctive role of back pressure changes from the altered systemic vasculature; LV hypertrophy, diastolic dysfunction, and raised LV end‐diastolic pressure, mediate this constellation of events (Sehgal et al. ,b,c). This consideration, in a subset of BPD infants unresponsive to standard therapy, gains importance as conventional pulmonary vasodilators such as iNO and sildenafil may be ineffective or contraindicated.…”

Section: Introductionmentioning

confidence: 99%

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ACE inhibition for severe bronchopulmonary dysplasia - an approach based on physiology

et al. 2018

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Premature infants have a high incidence of bronchopulmonary dysplasia (BPD). Systemic hypertension, arterial thickness and stiffness, and increased systemic afterload may all contribute to BPD pathophysiology by altering left ventricular (LV) function and increasing pulmonary venous congestion by lowering end‐diastolic compliance. This case series studied the usefulness of angiotensin‐converting enzyme (ACE) inhibition by measuring clinical and echocardiographic improvements in six consecutive infants with “severe” BPD unresponsive to conventional therapy. The range of gestation and birthweight were 23–29 weeks and 505–814 g, respectively. All required mechanical ventilation (including high‐frequency oscillation) and all but one were administered postnatal corticosteroids. Other treatments including sildenafil and diuretics made no clinical improvements. Captopril was started for systemic hypertension after cardiac and vascular ultrasounds which were repeated 5 weeks later. A significant reduction in oxygen (55 ± 25 to 29 ± 3%, two‐tailed P = 0.03) and ventilator requirements, and improved cardiovascular parameters were noted. This included a trend toward reduction in aorta intima media thickness [840 ± 94 to 740 ± 83 μm, P = 0.07] and an increased pulsatile diameter [36 ± 14 to 63 ± 25 μm, P = 0.04]). Improvements were observed for both systolic (increased LV output, 188 ± 13 to 208 ± 13 mL/kg/min, P = 0.046 and mean velocity of circumferential fiber shortening, 1.6 ± 0.2 to 2.5 ± 0.3 [circ/sec], P = 0.0004) and diastolic (decreased isovolumic relaxation time, 69.6 ± 8.2 to 59.4 ± 5 msec, P = 0.044) function which was accompanied by increased pulmonary vein flow. Right ventricular output increased accompanied by a significant lowering of pulmonary vascular resistance. These findings suggest that improving respiratory and cardiac indices (especially diastolic function) warrants further exploration of ACE inhibition in BPD infants unresponsive to conventional therapy.

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Section: Introductionmentioning

confidence: 76%

Section: Introductionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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ACE inhibition for severe bronchopulmonary dysplasia - an approach based on physiology

et al. 2018

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“…Knowledge of right ventricular function and pulmonary arterial circulation and its affinity with airway obstruction and lung function after extremely preterm birth is limited. Previous studies in infancy have reported increasingly impaired right ventricular function in relation to prolonged duration of respiratory support in extremely preterm infants with severe bronchopulmonary dysplasia (BPD) . BPD is known to contribute to elevated pulmonary arterial vascular resistance in infancy, and if this should persist, it may induce long‐standing changes in the right ventricular geometry, structure, and function .…”

Section: Introductionmentioning

confidence: 99%

Lung function and pulmonary vascular resistance are not associated in 6‐year‐old children born extremely preterm

et al. 2019

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Aim Children born preterm are at increased risk of reduced lung function. The aim was to test whether lung function was associated with pulmonary vascular resistance. Methods Participants were recruited from a population‐based cohort born in 2004‐2007. Lung function was assessed with spirometry after administration of a beta2‐agonist. Forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) were determined. Estimations of pulmonary vascular resistance, arterial dimensions, right ventricular wall thickness, sphericity, and systolic (TAPSE) and diastolic functions were performed with echocardiography. Adjusted regression analyses were used to study associations. Results Sixty‐six children (33 boys) born at 22‐26 weeks of gestational age (birthweights 460‐1134 g) were assessed at a mean age of 6.7 years. Despite large variations in lung function with FVC z‐scores ranging from −4.6 to +2.8, there were no associations between lung function and pulmonary arterial pressure, right ventricular structure or function. Children with higher FVC z‐scores (r = .52, β = .55 mm, P = .015) and higher FEV1 z‐scores (r = .58, β = .73 mm, P = .001) exhibited larger pulmonary arteries. Conclusion In children born extremely preterm, lung function was not associated with pulmonary vascular resistance. Routine echocardiographic evaluation of extremely preterm children may not be indicated at age 6.5 years.

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Focused Ultrasound in Right Ventricular Function and Pulmonary Hypertension

Bhombal,

Noori,

Singh

et al. 2023

Point-of-Care Ultrasound for the Neonatal and Pediatric Intensivist

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Right Ventricular Function in Infants with Bronchopulmonary Dysplasia: Association with Respiratory Sequelae

Cited by 42 publications

References 26 publications

ACE inhibition for severe bronchopulmonary dysplasia - an approach based on physiology

ACE inhibition for severe bronchopulmonary dysplasia - an approach based on physiology

Lung function and pulmonary vascular resistance are not associated in 6‐year‐old children born extremely preterm

Focused Ultrasound in Right Ventricular Function and Pulmonary Hypertension

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