1236 CONTRIBUTION OF LEFT-TO-RIGHT (L→R) DUCTUS ARTERIOSUS SHUNTING (DUCT SHUNT) TO PULMONARY BLOOD FLOW (PBF) IN PREMATURE LAMBS WITH AND WITHOUT HYALINE MEMBRANE DISEASE (HMD) DURING THE FIRST HOURS OF LIFE

Vascular Anomalies ◽

Hyaline Membranes ◽

A very interesting brief case report, entitled "Pulmonary Hyaline Membranes and Vascular Anomalies of the Lung," was published in Pediatrics by Bozic. This case is commonly referred to as the "Lausanne baby" and is used by many to support the hypothesis that hyaline membrane disease is primarily related to reduced pulmonary blood flow. Although there are good reasons from observations in both man and animal to implicate reduced pulmonary blood flow as an important factor in the pathophysiology of hyaline membrane disease, we do not believe the "Lausanne baby" can be used to support this hypothesis.

PULMONARY BLOOD FLOW (PBF) IN LAMBS WITH HYALINE MEMBRANE DISEASE (HMD)

Pediatric Research ◽

10.1203/00006450-197404000-00617 ◽

1974 ◽

Vol 8 (4) ◽

pp. 443-443

Author(s):

Alexander C Allen ◽

Dora A Stinson ◽

Hugh M MacDonald ◽

Paul M Taylor

Keyword(s):

Blood Flow ◽

Pulmonary Blood Flow ◽

HYALINE-MEMBRANE DISEASE AND PULMONARY BLOOD-FLOW

The Lancet ◽

10.1016/s0140-6736(65)90223-0 ◽

1965 ◽

Vol 286 (7401) ◽

pp. 42

Author(s):

HenryK. Silver

Keyword(s):

Blood Flow ◽

Pulmonary Blood Flow ◽

Circulatory changes following premature delivery in a baboon model of hyaline membrane disease

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.1991.261.4.h1148 ◽

1991 ◽

Vol 261 (4) ◽

pp. H1148-H1154 ◽

Cited By ~ 3

Author(s):

J. P. Kinsella ◽

D. R. Gerstmann ◽

R. A. Delemos

Keyword(s):

Blood Flow ◽

Systemic Vascular Resistance ◽

Vascular Resistance ◽

Oxygen Transport ◽

Ductus Arteriosus ◽

Premature Delivery ◽

Organ Blood Flow ◽

Hemodynamic Changes ◽

The premature baboon delivered by hysterotomy at 140 +/- 2 days (75%) gestation develops hyaline membrane disease (HMD) and left-to-right (L-R) shunting through the patent ductus arteriosus (PDA). To characterize hemodynamic changes that follow premature delivery, we measured systemic and organ blood flow, oxygen transport, and systemic vascular resistance over the first 96 h of life. We compared these measurements with those from more mature animals of the same species. Radiolabeled microspheres were used to measure organ blood flow (in ml.min-1.g-1) at 3 (n = 18), 23 (n = 17), and 96 h (n = 4) in the premature animals, and at 13 +/- 4 mo in the older animals (n = 5). Premature animals demonstrated over the first 96 h of life significant hemodynamic changes that included decreased systemic vascular resistance (P less than 0.001), increased systemic (P less than 0.05), intestinal (P less than 0.05), and hepatic blood flow (P less than 0.05), as well as resolution of L-R PDA shunting. These 96-h values were similar to those of the more mature infant baboons. Blood flow and oxygen transport to the kidneys and cerebrum did not significantly increase over the first 96 h in premature baboons and were significantly less than those of 13-mo-old animals (P less than 0.01, both). We speculate that low renal and cerebral blood flow in the 140-day premature baboon are manifestations of multisystem immaturity and, as such, may represent persistent physiological disturbances that are distinct from the severity of underlying lung disease in HMD.

The Use of Priscoline in the Treatment of the Hypoperfusion Syndrome

PEDIATRICS ◽

10.1542/peds.36.1.149 ◽

1965 ◽

Vol 36 (1) ◽

pp. 149-149 ◽

Cited By ~ 1

Author(s):

ERNEST K. COTTON

Keyword(s):

Blood Flow ◽

Drug Therapy ◽

Pulmonary Blood Flow ◽

In line with the report on pulmonary hypoperfusion as a possible mechanism in the etiology of hyaline membrane disease, we have been carrying out studies on newly born infants with this disease in order to correct the diminished pulmonary blood flow. We have used drug therapy on a total of 5 infants, and this has been associated with considerable normalizing in various abnormalities caused by the disease. We have first corrected acidosis when present, and then given tolazoline HC1 (Priscoline).

Unilateral Pulmonary Interstitial Emphysema: A Surgical Approach to Treatment

PEDIATRICS ◽

10.1542/peds.68.4.510 ◽

1981 ◽

Vol 68 (4) ◽

pp. 510-514

Author(s):

David H. Levine ◽

David S. Trump ◽

Glenn Waterkotte

Keyword(s):

Mechanical Ventilation ◽

Blood Flow ◽

Surgical Approach ◽

Pulmonary Blood Flow ◽

Illustrative Case ◽

Pulmonary Interstitial Emphysema ◽

Interstitial Emphysema ◽

Hyaline Membrane ◽

Ventilator Therapy

Pulmonary interstitial emphysema is a condition that has become a significant problem chiefly as a complication of mechanical ventilation of the newborn. In its severe forms, it may compromise ventilation and restrict pulmonary blood flow to the degree that it becomes a significant cause of mortality. When its occurrence is unilateral, or predominantly so, it becomes more amenable to therapy. A number of different approaches have been described, especially for milder forms of the disease, but none has proved entirely satisfactory. A surgical approach has been used in four patients with severe unilateral pulmonary interstitial emphysema complicating ventilator therapy for hyaline membrane disease. The technique was successful in three of the four infants. An illustrative case is described, as well as the selective criteria for application of the technique.

Stenting of the ductus arteriosus in neonates with ductus-depending pulmonary blood flow

Russian Journal of Thoracic and Cardiovascular Surgery ◽

10.24022/0236-2791-2017-59-4-246-251 ◽

2017 ◽

Vol 59 (4) ◽

pp. 246-251

Author(s):

B.M. Rakhmatov

Keyword(s):

Blood Flow ◽

Pulmonary Blood Flow ◽

Ductus Arteriosus

Serial Assessment of Ductus Arteriosus Hemodynamics in Hyaline Membrane Disease

PEDIATRICS ◽

10.1542/peds.98.6.1149 ◽

1996 ◽

Vol 98 (6) ◽

pp. 1149-1153

Author(s):

Ernest Z. Phillipos ◽

Murray A. Robertson ◽

Paul J. Byrne

Keyword(s):

Clinical Outcome ◽

Linear Relationship ◽

Aortic Root ◽

Left Atrial ◽

Ductus Arteriosus ◽

Root Diameter ◽

Shunt Volume ◽

Hyaline Membrane ◽

The Mean

Objectives. To assess the efficacy of Doppler echocardiography (DE) in the quantification of patent ductus arteriosus (PDA) shunt volume and to correlate PDA shunt volume with clinical outcome in infants with hyaline membrane disease. Methods. Ninety-eight DE studies were performed in 30 preterm ventilated infants with hyaline membrane disease within the first 24 hours of age and then at 48-hour intervals to a maximum of three studies while ventilated with a final study after extubation. Right and left ventricular outputs (QRV and QLV, respectively) and PDA flow were calculated using cross-sectional area and flow velocity integrals. Left atrial-to-aortic root diameter measurements were also taken. Clinical outcomes were correlated with the shunt fraction (QLV/QRV). Results. QLV/QRV demonstrated a linear relationship with the left atrial-to-aortic root diameter ratio (n = 92; r = .79). In the absence of a PDA (n = 33 studies), QRV versus QLV demonstrated a linear relationship (r = .88). In the presence of a PDA (n = 64 studies) the mean QLV (334 ± 133 ml/kg per minute) was significantly greater than the mean QRV (237 ± 84 ml/kg per minute). There was a linear relationship between QLV - QRV (PDA shunt volume) and PDA flow (n = 60; r = .84). In studies with exclusive left-to-right shunting at the PDA (n = 48), the mean QLV - QRV (112 ± 83 ml/kg per minute) was significantly higher than in those with bidirectional shunting (n = 16; mean QLV - QRV = 50 ± 27 ml/kg per minute). Two infants with severe intraventricular hemorrhage (IVH grade 3) and two infants with periventricular leukomalacia (PVL) had significantly higher QLV/QRV (2.09 ± 0.36 and 1.67 ± 0.02 respectively) than those with no IVH (n = 6; QLV/QRV = 1.31 ± 0.18) or those with IVH grades 1 and 2 (n = 8; QLV/QRV = 1.48 ± 0.27). There was no difference in QLV/QRV in infants with or without bronchopulmonary dysplasia retinopathy of prematurity. Necrotizing enterocolitis did not develop in any of the 30 infants. Conclusion. PDA shunt volume can be quantified by DE. Larger studies are needed to correlate clinical outcome with QLV/QRV.

Abstract 14860: Echocardiographic Assessment of Shunt Fraction in Complex Cyanotic Heart Diseases Palliated With Aortopulmonary Shunts

Circulation ◽

10.1161/circ.142.suppl_3.14860 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Joan K Lee ◽

briana olson ◽

Neal Jorgensen ◽

Matthew D Files

Keyword(s):

Blood Flow ◽

Pulmonary Blood Flow ◽

Heart Diseases ◽

Heart Defects ◽

Ductus Arteriosus ◽

Ventricular Volume ◽

Systemic Circulation ◽

Repeated Measurements ◽

Observer Agreement ◽

Shunt Fraction

Introduction: Neonates with complex heart defects with inadequate pulmonary blood flow require aortopulmonary shunts (APS) either as surgical-placed modified Blalock-Taussig shunt or a catheter-based stent implantation into a patent ductus arteriosus. An ideal APS provides equal pulmonary blood flow (Qp) as the systemic blood flow (Qs), which is considered balanced circulation. Pulmonary over-circulation leads to complications from inadequate systemic circulation, such as organ dysfunction, shock, and death. Accurately determining Qp:Qs ratio in these patients relies on catheterization, which is invasive and may falsely lower the Qp due to anesthetic effects. To our knowledge, there has not been any studies on echocardiographic comparisons of balanced versus overcirculated APS. We aim to evaluate echocardiographic Doppler assessment of velocity-time integral (VTI) at the aortic arch isthmus distal to APS origin as a measure of shunt fraction in APS patients. We defined shunt fraction ratio (SFR) as retrograde to prograde flow by VTI. Methods: This is a retrospective pilot study of neonates with APS. We selected two cohorts of patients with appropriately balanced circulation (n=12) and those with excessive Qp (n=5) resulting in end-organ damage. We analyzed serial echocardiograms, with repeated measurements for inter-observer agreement. Results: Mean SFR is lower in balanced cohort compared to the overcirculated cohort (0.45 ± 0.07 vs. 0.55 ± 0.09, p=0.02). For both groups, SFR was positively associated with oxygen saturation (r= 0.57, p=0.01), as well as markers of ventricular volume load, such as the highest brain naturetic peptide during hospitalization (Pearson’s correlation r=0.83, p= 0.04) and as outpatient (r= 0.72, p =0.02). Inter-observer agreement was 0.74, suggesting that this is a reproducible technique. Conclusions: SFR by VTI is a simple echocardiographic technique to estimate the volume of APS flow and appears to have important implications for clinical outcomes. Prompt characterization of pulmonary overcirculation without invasive assessment could improve clinical management. Further prospective studies are needed to validate these findings.