scholarly journals Digital Subtraction Pulmonary Angiography in Children with Pulmonary Hypertension due to Bronchopulmonary Dysplasia

2019 ◽  
Vol 7 (2) ◽  
pp. 26 ◽  
Author(s):  
Bibhuti Das ◽  
Michelle-Marie Jadotte ◽  
Jaime Mills ◽  
Kak-Chen Chan
Keyword(s):  
Pulmonary Hypertension ◽  
Vascular Disease ◽  
Bronchopulmonary Dysplasia ◽  
Preliminary Data ◽  
Pulmonary Arteries ◽  
Pulmonary Angiography ◽  
Pulmonary Vascular Disease ◽  
Digital Subtraction ◽  
Extreme Prematurity

Bronchopulmonary dysplasia (BPD) is the most common respiratory sequelae of prematurity and histopathologically features fewer, dysmorphic, pulmonary arteries. We present our experience with the digital subtraction pulmonary angiography (DSPA) findings of a segmental vascular filling abnormality in three children who were born at extreme prematurity and have pulmonary hypertension due to severe BPD. Our preliminary data suggest that DSPA may be useful in evaluating the severity of pulmonary vascular disease in children with BPD.

Morphology of the elastic pulmonary arteries in pulmonary hypertension: a quantitative study

1999 ◽  
Vol 9 (4) ◽  
pp. 364-370 ◽  
Author(s):  
Karen A. McLeod ◽  
Leon M. Gerlis ◽  
Gordon J. Williams
Keyword(s):  
Pulmonary Hypertension ◽  
Vascular Disease ◽  
Intravascular Ultrasound ◽  
Morphological Changes ◽  
Pulmonary Arteries ◽  
Sudden Infant Death ◽  
Pulmonary Vascular Disease ◽  
Sudden Infant ◽  
Major Drawback ◽  
Medial Thickening

AbstractRecent studies of intravascular ultrasound of the pulmonary arteries suggest that the technique can detect intimal and medial thickening in patients with pulmonary hypertension, potentially providing a method of assessing severity of pulmonary vascular disease in life. A major drawback of the technique is that only the elastic pulmonary arteries are accessible to current ultrasound catheters. The aim of this study was to determine whether morphological changes in vessels accessible to intravascular imaging reflect severity of pulmonary vascular disease and are of a sufficient degree to be detectable by current ultrasound catheters. Morphometric studies of the elastic pulmonary arteries were performed in specimens of lungs from 24 patients who had died with pulmonary hypertension (aged 3 weeks–9 years) and compared with measurements from infants who had died from sudden infant death syndrome. Morphological changes evident in the elastic pulmonary arteries in pulmonary hypertension included luminal dilation and medial thickening but these changes were too variable to be predictive of the severity of peripheral pulmonary vascular disease. Intimal thickening and atherosclerosis were present only in those with advanced pulmonary hypertensive disease. The changes of medial thickening and luminal dilation, nonetheless, are too variable to be predictive of the severity of peripheral pulmonary vascular disease. Thus, imaging by intravascular ultrasound may help confirm advanced pulmonary vascular disease, but is unlikely to differentiate less severe pulmonary vascular disease when the patient may still potentially be operable.

PREOPERATIVE EVALUATION OF THE PULMONARY VASCULAR BED IN PATIENTS WITH PULMONARY HYPERTENSION ASSOCIATED WITH LEFT TO RIGHT SHUNTS

PEDIATRICS ◽  
1959 ◽  
Vol 24 (3) ◽  
pp. 448-454
Author(s):  
I. Hunter Crittenden ◽  
Forrest H. Adams ◽  
Harrison Latta
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Vascular Disease ◽  
Preoperative Evaluation ◽  
Pulmonary Arteries ◽  
Operative Risk ◽  
Pulmonary Vascular Disease ◽  
Vascular Bed ◽  
The Media ◽  
Index Of Severity

Eighteen patients with pulmonary hypertension associated with left to right cardiac shunts have been studied using acetylcholine injected into the pulmonary artery to determine the distensibility of the vascular bed. The response is considered as an index of severity of vascular disease and of operative risk. Six cases failed to respond to the drug. One of these had received atropine, and the data may not be reliable. Five were 6 years of age or older and had relatively less left to right shunting than the others. Surgery was performed in two of this group of six, and it proved fatal. The small pulmonary arteries in both patients had marked intimal disease. All of the 12 cases that responded to acetylcholine had shunting of at least 140% of the systemic flow, and in five patients tested the shunt increased following injection of the drug. The five cases operated upon from this group had hypertrophy of the media of the small pulmonary arteries and in two cases minimal proliferation of the intima was present. The pulmonary artery pressures were similar in both groups. These observations suggest that the severity of pulmonary vascular disease may be predicted by the method described.

scholarly journals Pulmonary Vascular Disease in Bronchopulmonary Dysplasia

2016 ◽  
Vol 15 (2) ◽  
pp. 92-99 ◽  
Author(s):  
Steven H. Abman ◽  
Alicia Grenolds ◽  
Peter Mourani
Keyword(s):  
Pulmonary Hypertension ◽  
Vascular Disease ◽  
Bronchopulmonary Dysplasia ◽  
Premature Birth ◽  
Clinical Course ◽  
Diagnostic Evaluation ◽  
Pulmonary Vascular Disease ◽  
Premature Newborns ◽  
The Impact

Pulmonary vascular disease and pulmonary hypertension (PH) contributes significantly to the pathogenesis, pathophysiology, and clinical course of infants with bronchopulmonary dysplasia (BPD). This article briefly reviews the impact of premature birth on the developing lung circulation, mechanisms that contribute to the development of PH in premature newborns, and the diagnostic evaluation and management of severe PH in infants with BPD.

Pulmonary Vascular Disease in Secundum Atrial Septal Defect with Pulmonary Hypertension

CHEST Journal ◽  
1986 ◽  
Vol 89 (5) ◽  
pp. 694-698 ◽  
Author(s):  
Shigeo Yamaki ◽  
Togo Horiuchi ◽  
Makoto Miura ◽  
Yasuyuki Suzuki ◽  
Eiji Ishizawa ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Atrial Septal Defect ◽  
Vascular Disease ◽  
Septal Defect ◽  
Pulmonary Vascular Disease ◽  
Secundum Atrial Septal Defect

Somatic growth and the risks of bronchopulmonary dysplasia and pulmonary hypertension: connecting epidemiology and physiology

2019 ◽  
Vol 97 (3) ◽  
pp. 197-205 ◽  
Author(s):  
Mark A. Underwood ◽  
Stephen Wedgwood ◽  
Satyan Lakshminrusimha ◽  
Robin H. Steinhorn
Keyword(s):  
Pulmonary Hypertension ◽  
Bronchopulmonary Dysplasia ◽  
Somatic Growth ◽  
Postnatal Growth ◽  
Pulmonary Complications ◽  
Growth Restriction ◽  
Extreme Prematurity ◽  
Poor Growth ◽  
Increased Risk ◽  
Poor Nutrition

In the premature infant, poor growth in utero (fetal growth restriction) and in the first weeks of life (postnatal growth restriction) are associated with increased risk for bronchopulmonary dysplasia and pulmonary hypertension. In this review, we summarize the epidemiologic data supporting these associations, present a novel rodent model of postnatal growth restriction, and review 5 promising mechanisms by which poor nutrition may affect the developing lung. These observations support the hypothesis that nutritional and (or) pharmacologic interventions early in life may be able to decrease risk of the pulmonary complications of extreme prematurity.

scholarly journals Lower DLco% identifies exercise pulmonary hypertension in patients with parenchymal lung disease referred for dyspnea

2020 ◽  
Vol 10 (1) ◽  
pp. 204589401989191 ◽  
Author(s):  
Richard H. Zou ◽  
William D. Wallace ◽  
S. Mehdi Nouraie ◽  
Stephen Y. Chan ◽  
Michael G. Risbano
Keyword(s):  
Pulmonary Hypertension ◽  
Lung Disease ◽  
Vascular Disease ◽  
Pulmonary Function Tests ◽  
Pulmonary Vascular Disease ◽  
Chronic Obstructive ◽  
Exertional Dyspnea ◽  
Pulmonary Arterial ◽  
Parenchymal Lung Disease ◽  
Parenchymal Lung

Exercise pulmonary hypertension is an underappreciated form of physical limitation related to early pulmonary vascular disease. A low diffusing capacity of lungs for carbon monoxide (DLco) can be seen in patients with resting pulmonary hypertension as well as parenchymal lung disease. It remains unclear whether low DLco% identifies early pulmonary vascular disease. We hypothesize that a reduced DLco% differentiates the presence of exercise pulmonary hypertension in patients with parenchymal lung disease. Fifty-six patients referred for unexplained exertional dyspnea with pulmonary function tests within six months of hemodynamic testing underwent exercise right heart catheterization. Exclusion criteria included resting pulmonary arterial or venous hypertension. Receiver operator characteristic curve determined the optimal DLco% cutoffs based on the presence or absence of parenchymal lung disease. Twenty-one (37%) patients had parenchymal lung disease, most common manifesting as chronic obstructive lung disease or interstitial lung disease. In patients with parenchymal lung disease, a DLco of 46% demonstrated 100% sensitivity and 73% specificity for detecting exercise pulmonary hypertension. In patients without parenchymal lung disease, a DLco of 73% demonstrated 58% sensitivity and 94% specificity for detecting exercise pulmonary hypertension. In both cohorts, DLco% below the optimum cutoffs were associated with higher peak mean pulmonary arterial pressure and peak total pulmonary resistance consistent with the hemodynamic definition of exercise pulmonary hypertension. Patients with a DLco < 46% were more often treated with pulmonary vasodilators and had a trend to higher mortality and lung transplant. DLco% is a simple non-invasive screening test for the presence of exercise pulmonary hypertension in our mixed referral population with progressive exertional dyspnea. DLco < 46% with parenchymal lung disease and DLco < 73% without parenchymal lung disease may play a role in differentiating the presence of pulmonary vascular disease prior to invasive hemodynamic testing.

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