Journal article
How to diagnose and treat acute pulmonary hypertension when you have no cardiology support
Early human development, Vol.174, pp.105668-105668
11/01/2022
DOI: 10.1016/j.earlhumdev.2022.105668
PMID: 36155931
Abstract
Acute pulmonary hypertension (aPH) is a complex, physiology-driven disorder that causes critical illness in newborns, the hallmark of which is elevated pressure in the pulmonary vascular bed. Several underlying hemodynamic phenotypes exist, including classic arterial aPH with resistance-driven elevations in pulmonary arterial pressure (PAP), alongside flow-driven aPH from left-to-right shunt lesions, and primary left ventricular dysfunction with pulmonary venous hypertension and elevated left atrial pressure. Targeted neonatal echocardiography (TnECHO) is an important tool for evaluation of hemodynamics in aPH and is highly useful for evaluating modulators of disease and targeting cardiovascular therapy. The diagnostic approach to aPH includes confirmation of elevation of PAP, evaluation of the cause and exclusion of structural cardiac disease, assessment of the response of the myocardium to adverse loading conditions, and appraisal of the adequacy of systemic blood flow. Therapeutic goals include support of right ventricular (RV) function, RV afterload reduction, and selection of cardiotropic agents that support underlying pathophysiology without adverse effects on heart rate or pulmonary vascular resistance in addition to routine supportive intensive care. Training programs for TnECHO exist across multiple jurisdictions and strong correlation with pediatric cardiology assessment has been demonstrated. Future directions include adapting TnECHO training with a greater focus on achieving competency, and further research into the role of the modality in providing individualized cardiovascular care for patients with heterogenous underlying physiology, and its effect on key neonatal outcomes.
Details
- Title: Subtitle
- How to diagnose and treat acute pulmonary hypertension when you have no cardiology support
- Creators
- S. M. Boyd - Children's Hospital at WestmeadT. Chatmethakul - University of OklahomaP. J. McNamara - Univ Iowa, Stead Family Childrens Hosp, Stead Family Dept Pediat, Div Neonatol, Iowa City, IA USA
- Resource Type
- Journal article
- Publication Details
- Early human development, Vol.174, pp.105668-105668
- Publisher
- Elsevier
- DOI
- 10.1016/j.earlhumdev.2022.105668
- PMID
- 36155931
- ISSN
- 0378-3782
- eISSN
- 1872-6232
- Number of pages
- 11
- Language
- English
- Date published
- 11/01/2022
- Academic Unit
- Stead Family Department of Pediatrics; Neonatology; Internal Medicine
- Record Identifier
- 9984353950002771
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