Comprehensive Evaluation of Right Heart Performance and Pulmonary Hemodynamics in Neonatal Pulmonary Hypertension: Evaluation of cardiopulmonary performance in neonatal pulmonary hypertension

被引：16
作者：
Bhattacharya S. [1 ]
Sen S. [2 ]
Levy P.T. [3 ]
Rios D.R. [4 ]
机构：
[1] Division of Neonatology, Department of Paediatrics, Western University, London, ON
[2] Divisions of Neonatology and Pediatric Cardiology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
[3] Division of Newborn Medicine, Boston Children’s Hospital and Department of Pediatrics, Harvard Medical School, 300 Longwood Avenue, Hunnewell 436, Boston, 02115, MA
[4] Section of Neonatology, Department of Pediatrics, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX
来源：
Current Treatment Options in Cardiovascular Medicine | 2019年 / 21卷 / 2期
关键词：
Echocardiography; Heart function; Neonatology; Pulmonary hypertension; Right ventricle;
D O I：
10.1007/s11936-019-0713-8
中图分类号：
学科分类号：
摘要：
Purpose of review: Pulmonary hypertension is characterized by an elevation of pulmonary artery pressures and prolonged exposure of the right ventricle to high afterload that collectively contribute to morbidity and mortality in both the term and preterm infants. This review summarizes the pathogenesis, etiologies, and hemodynamic profiles of the conditions that result in pulmonary hypertension in neonates. We explore the application of echocardiographic techniques for the assessment of right ventricular performance and pulmonary hemodynamics that enhance and guide the diagnosis and management strategies in neonates. Recent findings: Clinical assessments based on the determinants of mean pulmonary artery pressures (pulmonary vascular resistance, pulmonary blood flow, and pulmonary capillary wedge pressure) provide a physiologic approach in determining the acute and chronic etiologies of pulmonary hypertension in neonates. In addition, advances in neonatal echocardiography now afford the capability to obtain quantitative information that often precedes the qualitative information acquired by conventional methods and also provide sensitive markers of right ventricle performance for prognostic information based on the determinants of mean pulmonary artery pressures. Summary: Neonatal pulmonary hypertension represents a physiologic spectrum that accounts for the variance in clinical presentation and response to therapies. Physiology-based approaches to etiological identification, coupled with the emerging echocardiographic methods for the assessment of pulmonary hypertension in neonates will likely help to identify cardiovascular compromise earlier, guide therapeutic intervention, monitor therapeutic effectiveness, and improve overall outcome. © 2019, Springer Science+Business Media, LLC, part of Springer Nature.
引用
收藏
相关论文
共 59 条
[1]  
Jain A., McNamara P.J., Persistent pulmonary hypertension of the newborn: advances in diagnosis and treatment, Semin Fetal Neonatal Med, 20, pp. 262-271, (2015)
[2]  
Haddad F., Hunt S.A., Rosenthal D.N., Murphy D.J., Right Ventricular function in cardiovascular disease, part I: anatomy, physiology, aging, and functional assessment of the right ventricle, Circulation, 117, pp. 1436-1448, (2008)
[3]  
Paige S.L., Plonowska K., Xu A., Wu S.M., Molecular regulation of cardiomyocyte differentiation, Circ Res, 116, pp. 341-353, (2015)
[4]  
Mielke G., Benda N., Cardiac output and central distribution of blood flow in the human fetus, Circulation, 103, pp. 1662-1668, (2001)
[5]  
Hendson L., Emery D.J., Phillipos E.Z., Bhargava R., Olley P.M., Lemke R.P., Persistent pulmonary hypertension of the newborn presenting as the primary manifestation of intracranial arteriovenous malformation of the vein of Galen, Am J Perinatol, 17, pp. 405-410, (2000)
[6]  
Tiwary S., Geethanath R.M., Abu-Harb M., Vein of Galen malformation presenting as persistent pulmonary hypertension of newborn (PPHN), BMJ Case Rep, (2013)
[7]  
Rothstein R., Paris Y., Quizon A., Pulmonary hypertension, Pediatr Rev, 30, pp. 39-45, (2009)
[8]  
Bussmann N., El-Khuffash A., Breatnach C.R., McCallion N., Franklin O., Singh G.K., Et al., Left ventricular diastolic function influences right ventricular — pulmonary vascular coupling in premature infants, Early Hum Dev, 128, pp. 35-40, (2018)
[9]  
Giesinger R.E., Bailey L.J., Deshpande P., McNamara P.J., Hypoxic-ischemic encephalopathy and therapeutic hypothermia: the hemodynamic perspective, J Pediatr, 180, pp. 22-30, (2017)
[10]  
Drossner D.M., Kim D.W., Maher K.O., Mahle W.T., Pulmonary vein stenosis: prematurity and associated conditions, Pediatrics, 122, pp. e656-e661, (2008)
123456