Pulmonary artery pressure evaluated by pulsed Doppler echocardiography in children with a left-to-right intracardiac shunt

Pulmonary Arterial Pressure in Children with Allergic Rhinitis

Background

Chronic upper airway obstruction may lead to increased pulmonary arterial pressure in childhood. Allergic rhinitis is one of the frequent causes of upper airway obstruction by nasal blockage. The aims of the study were to evaluate the pulmonary arterial pressures in children with allergic rhinitis and the effect of topical corticosteroid therapy.

Methods

Forty-nine children composed of 27 subjects with seasonal and 22 subjects with perennial allergic rhinitis were enrolled in this study. The pulmonary arterial pressures were measured by using Doppler echocardiography.

Results

The pretreatment pulmonary arterial systolic, mean, and diastolic pressures of study group were significantly higher than in healthy controls (p < 0.05). The pulmonary arterial systolic and mean pressures of the patient group significantly decreased at the end of study (p < 0.05), whereas the decrease of the diastolic pressure was not statistically significant (p > 0.05) after the treatment of a topical corticosteroid, mometasone furoate (100 μg per day), for 8 weeks.

Conclusion

Our results showed that children with allergic rhinitis have higher pulmonary arterial pressure levels compared with healthy controls and that increased pulmonary arterial pressure levels due to allergic rhinitis are reversible by using nasal topical corticosteroids. Further studies are needed to determine the clinical aspect of increased pulmonary arterial pressure.

Neonatal oxygenation, pulmonary hypertension, and evolutionary adaptation to high altitude (2013 Grover Conference series)

Andeans and Tibetans have less altitude reduction in birth weight than do shorter-resident groups, but only Tibetans are protected from pulmonary hypertension and chronic mountain sickness (CMS). We hypothesized that differences in neonatal oxygenation were involved, with arterial O2 saturation (SaO2) being highest in Tibetans, intermediate in Andeans, and lowest in Han or Europeans, and that improved oxygenation in Andeans relative to Europeans was accompanied by a greater postnatal decline in systolic pulmonary arterial pressures (Ppasys ). We studied 41 healthy (36 Andeans, 5 Europeans) and 9 sick infants at 3,600 m in Bolivia. The SaO2 in healthy babies was highest at 6-24 hours of postnatal age and then declined, whereas sick babies showed the opposite pattern. Compared to that of 30 Tibetan or Han infants studied previously at 3,600 m, SaO2 was higher in Tibetans than in Han or Andeans during wakefulness and active or quiet sleep. Tibetans, as well as Andeans, had higher values than Han while feeding. The SaO2's of healthy Andeans and Europeans were similar and, like those of Tibetans, remained at 85% or above, whereas Han values dipped below 70%. Andean and European Ppasys values were above sea-level norms and higher in sick than in healthy babies, but right heart pressure decreased across 4-6 months in all groups. We concluded that Tibetans had better neonatal oxygenation than Andeans at 3,600 m but that, counter to our hypothesis, neither was SaO2 higher nor Ppa lower in Andean than in European infants. Further, longitudinal studies in these 4 groups are warranted to determine whether neonatal oxygenation influences susceptibility to high-altitude pulmonary hypertension and CMS later in life.

Release of NT-pro brain natriuretic peptide in children before and after adenotonsillectomy

OBJECTIVES

To measure serum B-type natriuretic peptide, especially N-terminal segment of its prohormone (NT-proBNP) and pulmonary arterial pressure levels and to determine whether NT-proBNP concentrations correlate with pulmonary arterial pressure levels in children before and after adenotonsillectomy.

METHODS

Twenty children with adenoid and tonsil hypertrophy and 20 healthy subjects were included in the study. Transthoracic echocardiography was performed in all patients to assess pulmonary artery systolic and diastolic pressure with cardiac dysfunction. The NT-proBNP was analyzed for correlation with pulmonary artery pressure.

RESULTS

Our results showed that prohormone serum concentrations and pulmonary arterial pressures were significantly higher in the study group than in the control group at the preoperative evaluation. A significant decrease was detected among patients after surgery (p<0.05). There was no significant difference between the study and control groups for prohormone serum concentration and pulmonary arterial pressure at the postoperative evaluation (p>0.05).

CONCLUSION

We found increased serum prohormone levels and height pulmonary artery pressures in the children with adenoid and tonsil hypertrophy when comparing with healthy subjects. Our study supported that increased serum prohormone levels and pulmonary artery pressures as a result of adenoid and tonsil hypertrophy are reversible. Pediatric cardiologs and otolaryngologs should keep in mind an increased pulmonary artery pressure during management of children with adenoid and tonsil hypertrophy. Furthermore, Doppler echocardiography may be useful in the monitoring of pulmonary arterial pressure and in the follow-up of surgical outcome of children with adenoid and tonsil hypertrophy.

Pulmonary arterial pressure in infants with laryngomalacia

OBJECTIVE

Persistent upper airway obstruction may lead to increased pulmonary arterial pressure in childhood. Laryngomalacia is one of the most common causes of transient upper airway obstruction by laryngeal blockage in infants. The aim of the study is to evaluate the pulmonary arterial pressures in infants with laryngomalacia during infancy period.

METHODS

Fifteen infants with laryngomalacia and 30 healthy controls were enrolled into this study. The pulmonary arterial pressures were measured by using Doppler echocardiography. Infants were also evaluated by clinical investigations, telecardiography and electrocardiography.

RESULTS

Our results showed that infants with laryngomalacia may have significantly higher pulmonary arterial pressure than healthy subjects. Pressures of patient group were significantly decreased at the end of infancy period.

CONCLUSIONS

Increased pulmonary arterial pressure levels due to laryngomalacia are reversible by during developmental process. Therefore, in symptomatic period, evaluation of infants with laryngomalacia by using Doppler echocardiography may be useful for monitoring pulmonary arterial pressure and following up the clinical outcome.

Pulmonary arterial pressure in children with croup syndrome

PURPOSE

Croup syndrome or laryngotracheitis is one of the frequent causes of transient upper airway obstruction by laryngeal and tracheal blockage in infants and children. Upper airway obstruction may lead to increased pulmonary arterial pressure in children. In this study, the relationship between croup syndrome and pulmonary arterial pressure was investigated.

MATERIALS AND METHODS

Forty children with croup syndrome and 14 healthy, age- and sex-matched control subjects were enrolled in this study. Of all patients, 12 with severe symptoms, such as dyspnea, cyanosis, hypoventilation, were accepted as "high croup score" (croup score >or=6). All patients with high croup score were treated with dexamethasone. We assessed pulmonary arterial pressure of patients during therapy using serial echocardiographic measurements.

RESULTS

Our results showed that children with croup syndrome have significantly higher pulmonary arterial pressures than healthy subjects at the time of diagnosis. Pressure values of patients with high croup score were found to be significantly higher when compared with those of the low -core group (P < .05). However, there was no difference between 2 groups at the end of therapy.

CONCLUSIONS

It is suggested that pulmonary arterial pressure increased to different extents in the acute stage of illness and that the degree of increase was related to the severity of disease and average hospital stay. In addition, increased pulmonary arterial pressure due to croup syndrome is reversible. Furthermore, evaluation of children with croup syndrome by using Doppler echocardiography may be useful in the monitoring of pulmonary arterial pressure and in the follow-up of their therapy.

Doppler echocardiographic evaluation of pulmonary artery pressure in pneumonia of infants and children

Previously, there was insufficient evidence to confirm that pneumonia in infants and children might lead to the development of pulmonary hypertension. Recently, it has been shown that acceleration time corrected for heart rate (ATc) and the ratios of right ventricular preejection period to right ventricular ejection time (RPEP/RVET) and of right ventricular preejection period to acceleration time (RPEP/AT) derived from Doppler echocardiography correlated well with pulmonary artery pressure (PAP). To approach PAP in patients with infantile pneumonia, we measured RPEP/RVET, RPEP/AT, and ATc in 105 infants and children with pneumonia and in 17 controls, using a commercially available 2-dimensional echocardiograph (Toshiba SSH-40A) with SDS-21B Doppler unit. An increase of varying degrees in both ratios and ATc was noted during acute illness and significant differences in ratios RPEP/RVET and RPEP/AT were found among patients with mild, moderate, and severe disease. This suggested that PAP increased to different extents in the acute stage of illness and that the degree of increase was related to the severity of disease.