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Echocardiographic Screening for Pulmonary Hypertension (PH) in Infants with Bronchopulmonary Dysplasia (BPD)

Katy Tillman

E. Kirkpatrick

S. Berger


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Conference: 2011 PH Professional Network Symposium

Release Date: 09.22.2011

Presentation Type: Abstracts

K. Tillman, MSN, CPNP; E. Kirkpatrick, DO; S. Berger, MD
Children's Hospital of Wisconsin, Milwaukee, WI

PURPOSE: The specific aims of this study were to: 1) evaluate the echocardiographic patterns seen in infants with BPD screened for PH 2) determine the timing of when PH was detected and its echocardiographic course 3) identify ideal timing intervals for screening echocardiograms in patients with BPD.

BACKGROUND/SIGNIFICANCE: Bronchopulmonary dysplasia (BPD) is a chronic pulmonary disease that can occur in premature infants leading to derangement of normal lung development and can result in significant morbidity and mortality. Pulmonary hypertension (PH) can occur as a result of BPD, though the onset of PH can be insidious.

METHOD: A retrospective review of the echocardiogram findings in infants with BPD followed in the PH clinic. All echocardiograms of each patient were reviewed and evaluated for the presence of PH. Echocardiographic assessment for pulmonary hypertension (PH) was based upon the following criteria:

1) No evidence of PH:

a. TR gradient <2.8m/s (<30mmHg) and no findings suggestive of PH

2) Possible PH:

a. TR gradient <2.8m/s or <30mmHg AND other findings suggestive of PH OR
b. TR gradient ≥2.9m/s ( >34mmHg) and <3.2mmHg (40mmHg)

3) Likely PH:

a. TR gradient >3.2mmHg ( ≥40mmHg) OR
b. Septal bowing, in setting of RV dilation or hypertrophy

4) Unable to determine.

Echocardiograms that were deemed to have possible or likely PH were classified as having PH for this study.

FINDINGS: Analysis of data found that 17 patients were followed over an average time of 396 days (range 155 to 812 days) by serial echocardiography. There were a total of 133 echocardiograms available for review over this time period. Echocardiographic evidence of at least probable PH was found in the initial echo in 15 patients (88%). Three patients (18%) had initial echocardiograms showing severe PH and evidence of RV dysfunction. Five patients (29%) fluctuated between having evidence of PH and resolution of PH with serial echocardiography. Twelve patients (71%) had no evidence of PH on their echo by an average follow up of 248 days. Pulmonary hypertension was most prevalent during the first 120 days of life. Serial echocardiograms demonstrated a persistence of PH for the first 111 days followed by a trend of increasing negative echocardiograms for the next 180 days with a predominance of negative echocardiograms after 355 days of follow-up. These findings would suggest screening echocardiograms every 4 to 6 months.

CONCLUSION: This information allowed us to conclude the onset of PH is variable and can persist after the first year of life, initial presentation of PH in BPD patients can be cor pulmonale, and abnormal echocardiograms require continued follow up for evaluation of PH status. There is a need for continued echo screening of PH patients with BPD. To best follow the infants at risk for developing PH our center has developed a screening echo protocol.