The overlooked left ventricle in persistent pulmonary hypertension of the newborn

AbdelMassih, Antoine; Hassan, Fatma E.; El-Gammal, Amira; Tawfik, M. Sabry; Nabil, Dina

doi:10.1080/14767058.2019.1598363

Cited by 7 publications

(3 citation statements)

References 10 publications

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“…There have been some studies exploring the effects of maternal HIV and anti-retroviral drugs on poor LV function after birth, none statistically significant (8)(9)(10). The significance of the severity of LV dysfunction in a cohort of newborns with PPHN was demonstrated by AbdelMassih et al (11). Various possible etiologies such as hypoxia, pressure and volume overload, and LV-RV interactions were suggested.…”

Section: Discussionmentioning

confidence: 99%

Left ventricular dysfunction in the immediate post-natal period

Vijayashankar¹,

Sanatani²,

Franciosi³

et al. 2023

Transl Pediatr

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The successful transition from intrauterine to extrauterine life depends on a series of complex and immediate cardiovascular changes related to the change from a placental circulation to autonomous life sustained by the cardiorespiratory system (1). These changes include rapid alterations in systemic and pulmonary pressures, oxygen tension, adaptations to breathing air, and variations in the endocrine environment within minutes to hours of life (2,3).In particular, the left ventricle (LV) is required to make a significant change in cardiac output at birth, increasing its capacity from 1ml/kg/min to 2 mL/kg/min in a period of minutes to hours (2).Known causes of LV dysfunction after birth include severe hypoxia, acidosis, congenital cardiomyopathies, and structural congenital heart disease (4). The objective of this retrospective cohort analysis was to study the clinical presentation, echocardiographic findings and outcomes of

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Section: Discussionmentioning

confidence: 99%

Left ventricular dysfunction in the immediate post-natal period

Vijayashankar¹,

Sanatani²,

Franciosi³

et al. 2023

Transl Pediatr

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“…The global functions of the RV were estimated by measuring the myocardial performance index (MPI) on the lateral tricuspid annulus utilizing the pulsed tissue Doppler approach as per the following expression: the product of the relaxation times and isovolumetric contraction (IRT and ICT) split by the ejection time (ET); and MPI equals (ICT+IRT)/ET. (11) The normal mean value of RVMPI is 0.28±0.04 (10,(12)(13)(14). We used RVMPI > 0.32 as a cutoff value to indicate global RV dysfunction in this study.…”

Section: Methodsmentioning

confidence: 99%

Exercise Limitation in Children after Tetralogy of Fallot Repair Is Not related to Right Ventricular Dysfunction: Single Egyptian Center Experience

Ibrahim

Mostafa

Ahmed

et al. 2022

Pediatric Sciences Journal

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Background: Tetralogy of Fallot (TOF) is one of the most prevalent cyanotic congenital heart diseases requiring surgery early in life. Aim of work: Exercise capacity and right ventricular diastolic dysfunction in children after TOF repair. Methods: Cross sectional descriptive study was conducted on 27 cases with TOF after total surgical repair. Cases were subjected to 12 leads ECG, chest X-ray, 6-minute walking test (6MWT) to assess the exercise capacity and transthoracic color Doppler echocardiography with assessment of right ventricle myocardial performance index (RVMPI) and pulmonary regurgitation index (PRi). Results: The mean ± SD age of the our studied was TOF patients 6.59 ± 1.80 years. The mean ± SD age at operation was 2.46 ± 0.95 years. All had dilated right ventricle (right ventricle dilatation index RVDi > 0.5), and moderate to severe pulmonary regurge (PR) estimated by PRi (PRi <0.77). Impaired RVMPI (>0.32) was found in 6 (22%) patients. Exercise capacity measured by 6-MWT was significantly reduced compared to the normal population of the same age group (p= 0.001). Results of 6-MWT did not correlate with the RVMPI (p= 0.44, r= -0.077), the PRi (p= 0.83, r=0.006), QRS (p=0.31, r=0.066), or corrected QT interval (p=0.89, r= 0.169). Conclusion: Exercise capacity was limited in our TOF patients after surgical repair, that was not related to right ventricular diastolic dysfunction as it did not correlate with RVMPI, degree of PR, QRS duration, nor corrected QT interval.

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“…Abnormal pulmonary vasoreactivity and structural changes in pulmonary vessel walls have been considered the main causes of PPHN ( 2 ). However, there is some evidence that cardiac dysfunction may play a major role in PPHN ( 3 , 4 ). Severe pulmonary hypertension increases RV afterload, which may result in RV failure.…”

Section: Introductionmentioning

confidence: 99%

Diastolic ventricular function in persistent pulmonary hypertension of the newborn

et al. 2023

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BackgroundPersistent pulmonary hypertension of the newborn (PPHN) is usually considered a consequence of impaired pulmonary circulation. However, little is known regarding the role of cardiac dysfunction in PPHN. In this study, we hypothesized that the tolerance for pulmonary hypertension in newborn infants depends on the biventricular function. The aim of this study is to evaluate biventricular cardiac performance by using Tissue Doppler Imaging (TDI) in an healthy newborn infants with asymptomatic pulmonary hypertension and in newborn infants with PPHN.MethodsRight and left cardiac function were investigated using conventional imaging and TDI in 10 newborn infants with PPHN (“PPHN”) and 10 asymptomatic healthy newborn infants (“asymptomatic PH”).ResultsSystolic pulmonary artery pressure (PAP) as assessed by TDI and the mean systolic velocity of the right ventricular (RV) free wall were similar in both groups. The isovolumic relaxation time of the right ventricle at the tricuspid annulus was significantly longer in the “PPHN” than in the “asymptomatic PH” group (53 ± 14 ms vs. 14 ± 4 ms, respectively; p < 0.05). Left ventricular (LV) function was normal in both groups with a systolic velocity (S'LV) at the LV free wall groups (6 ± 0.5 cm/s vs. 8.3 ± 5.7 cm/s, p > 0.05).ConclusionThe present results suggest that high PAP with or without respiratory failure is not associated with altered right systolic ventricular function and does not affect LV function in newborn infants. PPHN is characterized by a marked right diastolic ventricular dysfunction. These data suggest that the hypoxic respiratory failure in PPHN results, at least in part, from diastolic RV dysfunction and right to left shunting across the foramen ovale. We propose that the severity of the respiratory failure is more related to the RV diastolic dysfunction than the pulmonary artery pressure.

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The overlooked left ventricle in persistent pulmonary hypertension of the newborn

Cited by 7 publications

References 10 publications

Left ventricular dysfunction in the immediate post-natal period

Left ventricular dysfunction in the immediate post-natal period

Exercise Limitation in Children after Tetralogy of Fallot Repair Is Not related to Right Ventricular Dysfunction: Single Egyptian Center Experience

Diastolic ventricular function in persistent pulmonary hypertension of the newborn

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