Valutazione del neonato con sospetta ipertensione polmonare

Size: px
Start display at page:

Download "Valutazione del neonato con sospetta ipertensione polmonare"

Transcription

1 Valutazione del neonato con sospetta ipertensione polmonare Cardiologia Pediatrica Seconda Università degli Studi di Napoli A.O. R.N. dei Colli-Monaldi Napoli

2 Hypoxiemic infant Full or near-term neonate O2 test: PaO2 >100mmHg: lung disease PaO mmHg: lung disease or congenital heart disease (CHD) PaO2 < 50mmHg: persitent pulmonary hypertension of the newborn (PPHN) or (CHD)

3 WHO classification of Pulmonary Hypertension Venice 2003 revised Dana Point Pulmonary arterial hypertension Idiopathic PAH Heritable PAH (BMPR2, ALK1..) Drugs and toxins Associated with CTD, HIV, portal hypertension, congenital heart diseases, chronic hemolytic anemia (SSD) and shistosomiasis Persistent pulmonary hypertension of the newborn (PPHN) 1 Pulmonary veno-occlusive disease (PVOD) or pulmonary capillary hemangiomatosis (PHCM) 2. PH with left heart disease Systolic dysfunction Diastolic dysfunction Valvular 3. PH with lung diseases/hypoxemia COPD Interstitial lung diseases Sleep-disordered breathing Altitude exposure Alveolar hypoventilation Developmental abnormalities 4. CTEPH No more distinction proximal/distal 5. Miscellaneous Sarcoidosis, histiocytosis X, Gaucher,..

4 PPHN First described in 1969 (PFC, persistent fetal circulation) PPHN usually presents at or shortly after birth, when the pulmonary vascular resistance (PVR) fails to decrease at birth. The affected infants fail to establish adequate oxygenation during postnatal life and may develop multi-organ dysfunction. Gersony, Circulation 1969

5 PPHN incidence: 2/1000 live birth Walsh-Sukys MC, Pediatrics 2000

6 PPHN The severity of PPHN can run the full spectrum from mild and transient respiratory distress to severe hypoxemia and cardio-pulmonary instability that require intensive care support. Prompt diagnosis and management, including a timely referral to a tertiary care center, can dramatically improve the chances of survival. Although mortality rates for PPHN were reported as 11 34% during 1980s, current mortality rates are <10% at most tertiary care centers. Hageman JR, Am J Dis Child Davis JM, Pediatr Pulmonol Konduri GG, Pediatrics 2004

7 PPHN: management Confirm diagnosis of PPHN Correct underlying abnormalities (hypothermia, acidosis, hypocalcemia, hypoglycemia, polycythemia); Oxygen by hood Conservative mechanical ventilation Trial of hyperventilation If low PO2, trial of rescue therapies Metabolic HFV Surfactant Vasodilators ECMO Alkalosis ino, PGD 2, PGI 2, Tolazoline, Adenosine, new PDE-i

8 PPHN or CHD?

9 Role of echocardiography It is important to perform echocardiography to exclude cardiac disease and to assess cardiac function. Infants with severe persistent hypoxaemia should be assessed by an experienced paediatric echocardiographer.

10 Echo findings in PPHN RV dilation Anomalous value of pulmonary ejection wave (AcT/ET <0.3) PAPs > 35 mmhg Right-to-left (or bidirectional) ductal or interatrial shunt

11 Estimation of Pulmonary Artery Pressure (PAP) Echocardiographic parameters (direct or indirect) Tricuspid Regurgitation Pulmonary regurgitation Ductal Flow Atrial Shunting Other Shunts Cardiac Function and Output

12 g3 g2 Tricuspid Regurgitation The peak velocity of the tricuspid regurgitation (TR) jet is a direct indicator of the right ventricular pressure (and therefore PAP) RV pressure = RA pressure + (4v 2 )

13 Diapositiva 12 g2 n This is the most accurate way of determining PAP. n The jet of blood leaking through the tricuspid valve is interrogated with Doppler giovannella.russo; 12/10/2013 g3 n It is important to know the systemic blood pressure to determine whether PAP is above systemic BP. giovannella.russo; 12/10/2013

14 Pulmonary artery pressure Mean pulmonary pressure = 79 (0.45 AcT) (Mahan) Pulmonary hypertension Vn = AcT >120 msec (PAPm < 25 mmhg) Normal pattern

15 Anomalous value of pulmonary ejection wave (AcT/ET <0.3)

16 Ductal Flow Pure right-to-left flow indicates that PAP is higher than aortic pressure throughout the cardiac cycle. Bidirectional flow occurs when the aortic and pulmonary pressures are approximately equal. Flow is left-to-right during diastole and right-to-left during systole (as the pulmonary arterial pressure wave reaches the duct before the aortic pressure wave). Bidirectional flow is common in healthy babies in the first 12 hours but changes to pure left-to-right when aortic pressures become higher than PA. gc1

17 Diapositiva 15 gc1 The direction and velocity of ductal blood flow can give useful information on PAP. gabriella carrozza; 13/10/2013

18 2 days newborn, severe PPHN (RV pressure 64mmHg)

19 Atrial Shunting Right-to-left atrial shunting reflects right atrial filling (diastolic) pressure or ventricular filling more than right ventricular systolic pressures. Some degree of right-to-left atrial shunting through the patent foramen ovale is common, although it is rare for this to be purely right-to-left (pure right-toleft flow is Totally Anomalous Pulmonary Venous Drainage [TAPVD]). Bowing of the interatrial septum to the left is commonly seen.

20 Other Shunts When the arterial duct in undetectable at echo or there s no evidence of tricuspid regurgitation, look for other shunt (i.e. small VSD)!!

21 Cardiac Function and Output Quantitative assessment of cardiac function may assist with decisions and assessments of the roles of inotropes, inhaled nitric oxide, and other interventions affecting cardiac output.

22 Dilated right chambers

23 TAPVD

24 TAPVD

25 Dilated right chambers

26 Aortic coarctation Valutazione Color-Doppler

27 Dilated right chambers

28 Critical PS with enlarged RV

29 Take - home message (PPHN) PPHN is uncommon. Clinical evaluation, O2 challenge, echo are mandatory for diagnostic work-up. Diagnosis is polyparametric. Echo is necessary to exclude CHD. Therapy: ino No randomized clinical trials but expert opinion

30

31 Elevated PAP is generally associated with decreased pulmonary blood flow and increased pulmonary vascular resistance. Not uncommonly, there is enlargement of the RV and RA, as well as the main pulmonary artery. There may be flattening or even bowing of the interventricular septum to the left if RV pressures exceed LV pressures. As cardiac output is dependent on venous return to the RA and LA, cardiac output (both RVO and LVO) is frequently reduced with PPHN. Severe PPHN may be associated with LVO below 100ml/kg/min (normal ml/kg/min)

32 tapvd

33 TAPVD The RV is enlarged and the LV is underfilled and "squashed". This is common in severe PPHN The RA and RV are grossly dilated, the LV is small, and another structure - the pulmonary venous chamber, PVC, - is seen (usually not as obviously as in this image)

34

35

36

PVDOMICS. Study Introduction. Kristin Highland, MD Gerald Beck, PhD. NHLBI Pulmonary Vascular Disease Phenomics Program

PVDOMICS. Study Introduction. Kristin Highland, MD Gerald Beck, PhD. NHLBI Pulmonary Vascular Disease Phenomics Program PVDOMICS Study Introduction Kristin Highland, MD Gerald Beck, PhD NHLBI Pulmonary Vascular Disease Phenomics Program Funded by the National Heart, Lung, and Blood Institute of the National Institutes of

More information

Pulmonary Hypertension in 2012

Pulmonary Hypertension in 2012 Pulmonary Hypertension in 2012 Evan Brittain, MD December 7, 2012 Kingston, Jamaica VanderbiltHeart.com Disclosures None VanderbiltHeart.com Outline Definition and Classification of PH Hemodynamics of

More information

Dr. Md. Rajibul Alam Prof. of Medicine Dinajpur Medical college

Dr. Md. Rajibul Alam Prof. of Medicine Dinajpur Medical college Dr. Md. Rajibul Alam Prof. of Medicine Dinajpur Medical college PULMONARY HYPERTENSION Difficult to diagnose early Because Not detected during routine physical examination and Even in advanced cases symptoms

More information

SA XXXX Special Authority for Subsidy

SA XXXX Special Authority for Subsidy SA XXXX Special Authority for Subsidy Special authority approved by the Pulmonary Arterial Hypertension (PAH) Panel. Application forms can be obtained from PHARMAC s website: www.pharmac.govt.nz or: PAH

More information

Neonatal and Pediatric Pulmonary Vascular Disease

Neonatal and Pediatric Pulmonary Vascular Disease Neonatal and Pediatric Pulmonary Vascular Disease Emma Olson, MS, ARNP Pediatric Cardiology Nurse Practitioner Canadian Respiratory Conference April 14, 2018 Financial Interest Disclosure (over the past

More information

ADCIRCA (tadalafil) The World Health Organization (WHO) has classified pulmonary hypertension into five different groups: (2)

ADCIRCA (tadalafil) The World Health Organization (WHO) has classified pulmonary hypertension into five different groups: (2) RATIONALE FOR INCLUSION IN PA PROGRAM Background Pulmonary arterial hypertension is a rare disorder of the pulmonary arteries in which the pulmonary arterial pressure rises above normal levels in the absence

More information

Recruitment and Consenting

Recruitment and Consenting 1 Recruitment and Consenting MOP Chapter 4 NHLBI Pulmonary Vascular Disease Phenomics Program Funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health with support from

More information

Paediatric PAH in the current era

Paediatric PAH in the current era Paediatric PAH in the current era Dunbar Ivy, MD The Children s Hospital Heart Institute University of Colorado School of Medicine Paediatric PAH in the current era & A Gap Analysis Dunbar Ivy, MD The

More information

Right Ventricular Failure and Pulmonary Hypertension 2011

Right Ventricular Failure and Pulmonary Hypertension 2011 Right Ventricular Failure and Pulmonary Hypertension 2011 George G. Sokos, DO FACC Assistant Professor of Medicine, Temple University Director, Advanced Heart Failure and Cardiac Transplant Fellowship

More information

PVDOMICS. Study Introduction. Kristin Highland, MD Gerald Beck, PhD. NHLBI Pulmonary Vascular Disease Phenomics Program

PVDOMICS. Study Introduction. Kristin Highland, MD Gerald Beck, PhD. NHLBI Pulmonary Vascular Disease Phenomics Program PVDOMICS Study Introduction Kristin Highland, MD Gerald Beck, PhD NHLBI Pulmonary Vascular Disease Phenomics Program Funded by the National Heart, Lung, and Blood Institute of the National Institutes of

More information

Disclosures. Objectives 6/16/2016. A Look at the Other Side: Focus on the Right Ventricle and Pulmonary Hypertension

Disclosures. Objectives 6/16/2016. A Look at the Other Side: Focus on the Right Ventricle and Pulmonary Hypertension A Look at the Other Side: Focus on the Right Ventricle and Pulmonary Hypertension Susan P. D Anna MSN, APN-BC, CHFN June 24, 2016 Disclosures Objectives Differentiate structure and function of RV and LV

More information

2/4/2011. Nathan Kerner, M.D.

2/4/2011. Nathan Kerner, M.D. Nathan Kerner, M.D. Definition Elevated pressures - cut off usually >40 mmhg pulmonary artery systolic pressure (PASP) Usually associated with elevated pulmonary vascular resistance (PVR) measured in dynessec/cm

More information

Pulmonary Hypertension: Another Use for Viagra

Pulmonary Hypertension: Another Use for Viagra Pulmonary Hypertension: Another Use for Viagra Kathleen Tong, MD Director, Heart Failure Program Assistant Clinical Professor University of California, Davis Disclosures I have no financial conflicts A

More information

Pulmonary Hypertension Perioperative Management

Pulmonary Hypertension Perioperative Management Pulmonary Hypertension Perioperative Management Bruce J Leone, MD Professor of Anesthesiology Chief, Neuroanesthesiology Vice Chair for Academic Affairs Mayo Clinic Jacksonville, Florida Introduction Definition

More information

REVATIO (sildenafil)

REVATIO (sildenafil) RATIONALE FOR INCLUSION IN PA PROGRAM Background Pulmonary arterial hypertension is a rare disorder of the pulmonary arteries in which the pulmonary arterial pressure rises above normal levels in the absence

More information

PDE5 INHIBITOR POWDERS Sildenafil powder, Tadalafil powder

PDE5 INHIBITOR POWDERS Sildenafil powder, Tadalafil powder RATIONALE FOR INCLUSION IN PA PROGRAM Background Sildenafil and Tadalafil are marketed as Revatio and Adcirca for pulmonary arterial hypertension. This is a rare disorder of the pulmonary arteries in which

More information

Appendix II: ECHOCARDIOGRAPHY ANALYSIS

Appendix II: ECHOCARDIOGRAPHY ANALYSIS Appendix II: ECHOCARDIOGRAPHY ANALYSIS Two-Dimensional (2D) imaging was performed using the Vivid 7 Advantage cardiovascular ultrasound system (GE Medical Systems, Milwaukee) with a frame rate of 400 frames

More information

Instructions: This form is completed and entered for all participants. Database will skip over sections that do not apply.

Instructions: This form is completed and entered for all participants. Database will skip over sections that do not apply. Revision of 08/30/2017 Form #102 Page 1 of 6 PVDOMICS STUDY PVD Assessment - Form #102 Instructions: This form is completed and entered for all participants. Database will skip over sections that do not

More information

Disclosures. Objectives. RV vs LV. Structure and Function 9/25/2016. A Look at the Other Side: Focus on the Right Ventricle and Pulmonary Hypertension

Disclosures. Objectives. RV vs LV. Structure and Function 9/25/2016. A Look at the Other Side: Focus on the Right Ventricle and Pulmonary Hypertension Disclosures A Look at the Other Side: Focus on the Right Ventricle and Pulmonary Hypertension No financial relationships Susan P. D Anna MSN, APN BC, CHFN September 29, 2016 Objectives RV vs LV Differentiate

More information

Clinical implication of exercise pulmonary hypertension: when should we measure it?

Clinical implication of exercise pulmonary hypertension: when should we measure it? Clinical implication of exercise pulmonary hypertension: when should we measure it? Jang-Young, Kim Wonju College of Medicine, Yonsei Univ. Exercise pulmonary hypertension (EPH) Introduction of pulmonary

More information

22nd Annual Heart Failure 2018 an Update on Therapy. Pulmonary Arterial Hypertension: Contemporary Approach to Treatment

22nd Annual Heart Failure 2018 an Update on Therapy. Pulmonary Arterial Hypertension: Contemporary Approach to Treatment 22nd Annual Heart Failure 2018 an Update on Therapy Pulmonary Arterial Hypertension: Contemporary Approach to Treatment Ronald J. Oudiz, MD, FACP, FACC, FCCP Professor of Medicine The David Geffen School

More information

Pulmonary hypertension

Pulmonary hypertension Pulmonary hypertension Rafael Hirsch, MD Adult Congenital Heart Unit Dept. of Cardiology, Beilinson Hospital-Rabin Medical Center and Sackler School of Medicine, Tel Aviv University Pulmonary hypertension?

More information

2nd ECHO ASE-ASEAN: Bangkok 22nd October DR. TAN JU LE Pulmonary Hypertension Services National Heart Centre SINGAPORE

2nd ECHO ASE-ASEAN: Bangkok 22nd October DR. TAN JU LE Pulmonary Hypertension Services National Heart Centre SINGAPORE 2nd ECHO ASE-ASEAN: Bangkok 22nd October 2016 DR. TAN JU LE Pulmonary Hypertension Services National Heart Centre SINGAPORE Definition of Pulmonary Hypertension and Cor Pulmonale Epidemiology and Pathophysiology

More information

Effective Strategies and Clinical Updates in Pulmonary Arterial Hypertension

Effective Strategies and Clinical Updates in Pulmonary Arterial Hypertension Effective Strategies and Clinical Updates in Pulmonary Arterial Hypertension Hap Farber Director, Pulmonary Hypertension Center Boston University School of Medicine Disclosures 1) Honoria: Actelion, Gilead,

More information

ELIGIBILITY CRITERIA FOR PULMONARY ARTERIAL HYPERTENSION THERAPY

ELIGIBILITY CRITERIA FOR PULMONARY ARTERIAL HYPERTENSION THERAPY ELIGIBILITY CRITERIA FOR PULMONARY ARTERIAL HYPERTENSION THERAPY Contents Eligibility criteria for Pulmonary Arterial Hypertension therapy...2-6 Initial Application for funding of Pulmonary Arterial Hypertension

More information

The World Health Organization (WHO) has classified pulmonary hypertension into five different groups: (2)

The World Health Organization (WHO) has classified pulmonary hypertension into five different groups: (2) Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.40.13 Section: Prescription Drugs Effective Date: July 1 2016 Subject: Tyvaso Page: 1 of 4 Last Review

More information

Cardiovascular Pathophysiology: Right to Left Shunts aka Cyanotic Lesions

Cardiovascular Pathophysiology: Right to Left Shunts aka Cyanotic Lesions Cardiovascular Pathophysiology: Right to Left Shunts aka Cyanotic Lesions Ismee A. Williams, MD, MS iib6@columbia.edu Pediatric Cardiology Learning Objectives To discuss the hemodynamic significance of

More information

Cardiovascular Pathophysiology: Right to Left Shunts aka Cyanotic Lesions Ismee A. Williams, MD, MS Pediatric Cardiology

Cardiovascular Pathophysiology: Right to Left Shunts aka Cyanotic Lesions Ismee A. Williams, MD, MS Pediatric Cardiology Cardiovascular Pathophysiology: Right to Left Shunts aka Cyanotic Lesions Ismee A. Williams, MD, MS iib6@columbia.edu Pediatric Cardiology Learning Objectives To discuss the hemodynamic significance of

More information

The World Health Organization (WHO) has classified pulmonary hypertension into five different groups: (2)

The World Health Organization (WHO) has classified pulmonary hypertension into five different groups: (2) Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.40.10 Subject: Uptravi Page: 1 of 6 Last Review Date: September 15, 2017 Uptravi Description Uptravi

More information

The World Health Organization (WHO) has classified pulmonary hypertension into five different groups: (2)

The World Health Organization (WHO) has classified pulmonary hypertension into five different groups: (2) Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.40.21 Subject: Orenitram Page: 1 of 6 Last Review Date: June 24, 2016 Orenitram Description Orenitram

More information

COMPLEX CONGENITAL HEART DISEASE: WHEN IS IT TOO LATE TO INTERVENE?

COMPLEX CONGENITAL HEART DISEASE: WHEN IS IT TOO LATE TO INTERVENE? COMPLEX CONGENITAL HEART DISEASE: WHEN IS IT TOO LATE TO INTERVENE? Aurora S. Gamponia, MD, FPPS, FPCC, FPSE OBJECTIVES Identify complex congenital heart disease at high risk or too late for intervention

More information

PERSISTENT PULMONARY HYPERTENSION OF THE NEWBORN East Bay Newborn Specialists Guideline Prepared by L Truong 12/15/2015

PERSISTENT PULMONARY HYPERTENSION OF THE NEWBORN East Bay Newborn Specialists Guideline Prepared by L Truong 12/15/2015 PERSISTENT PULMONARY HYPERTENSION OF THE NEWBORN East Bay Newborn Specialists Guideline Prepared by L Truong 12/15/2015 Background: Persistent pulmonary hypertension of the newborn occurs in ~2 per 1,000

More information

PPHN (see also ECMO guideline)

PPHN (see also ECMO guideline) Children s Acute Transport Service Clinical Guidelines PPHN (see also ECMO guideline) Document Control Information Author P Brooke E.Randle Author Position Medical Student Consultant Document Owner E.

More information

The World Health Organization (WHO) has classified pulmonary hypertension into five different groups: (2)

The World Health Organization (WHO) has classified pulmonary hypertension into five different groups: (2) Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.40.17 Subject: Remodulin Page: 1 of 5 Last Review Date: June 24, 2016 Remodulin Description Remodulin

More information

The World Health Organization (WHO) has classified pulmonary hypertension into five different groups: (3)

The World Health Organization (WHO) has classified pulmonary hypertension into five different groups: (3) Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.40.15 Subject: Flolan Veletri Page: 1 of 5 Last Review Date: September 15, 2017 Flolan Veletri Description

More information

Pulmonary Hypertension: Classification

Pulmonary Hypertension: Classification Pulmonary Hypertension: Pathophysiology and Classification M. Maggiorini Medical Intensive Care Unit University Hospital Zürich Pulmonary hypertension is a disease of the pulmonary circulation with many

More information

PULMONARY HYPERTENSION

PULMONARY HYPERTENSION PULMONARY HYPERTENSION REVIEW & UPDATE Olga M. Fortenko, M.D. Pulmonary & Critical Care Medicine Pulmonary Vascular Diseases Sequoia Hospital 650-216-9000 Olga.Fortenko@dignityhealth.org Disclosures None

More information

P = 4V 2. IVC Dimensions 10/20/2014. Comprehensive Hemodynamic Evaluation by Doppler Echocardiography. The Simplified Bernoulli Equation

P = 4V 2. IVC Dimensions 10/20/2014. Comprehensive Hemodynamic Evaluation by Doppler Echocardiography. The Simplified Bernoulli Equation Comprehensive Hemodynamic Evaluation by Doppler Echocardiography Itzhak Kronzon, MD North Shore LIJ/ Lenox Hill Hospital New York, NY Disclosure: Philips Healthcare St. Jude Medical The Simplified Bernoulli

More information

The World Health Organization (WHO) has classified pulmonary hypertension into five different groups: (2)

The World Health Organization (WHO) has classified pulmonary hypertension into five different groups: (2) Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.40.23 Subject: Sildenafil Citrate Powder Page: 1 of 6 Last Review Date: September 15, 2017 Sildenafil

More information

Ειδικές θεραπείες σε µη-αρτηριακή πνευµονική υπέρταση, πότε; - Στέλλα Μπρίλη Α Πανεπιστηµιακή Καρδιολογική Κλινική Ιπποκράτειο Νοσοκοµείο Αθηνών

Ειδικές θεραπείες σε µη-αρτηριακή πνευµονική υπέρταση, πότε; - Στέλλα Μπρίλη Α Πανεπιστηµιακή Καρδιολογική Κλινική Ιπποκράτειο Νοσοκοµείο Αθηνών Ειδικές θεραπείες σε µη-αρτηριακή πνευµονική υπέρταση, πότε; - Στέλλα Μπρίλη Α Πανεπιστηµιακή Καρδιολογική Κλινική Ιπποκράτειο Νοσοκοµείο Αθηνών . Updated Clinical Classification of Pulmonary Hypertension

More information

Echo Doppler Assessment of Right and Left Ventricular Hemodynamics.

Echo Doppler Assessment of Right and Left Ventricular Hemodynamics. Echo Doppler Assessment of Right and Left Ventricular Hemodynamics. Itzhak Kronzon, MD, FASE, FACC, FESC, FAHA, FACP, FCCP Northwell, Lenox Hill Hospital, New York Professor of Cardiology Hofstra University

More information

Pulmonary Hypertension: Echocardiographic Evaluation of Pulmonary Hypertension and Right Ventricular Function. Irmina Gradus-Pizlo, MD

Pulmonary Hypertension: Echocardiographic Evaluation of Pulmonary Hypertension and Right Ventricular Function. Irmina Gradus-Pizlo, MD Pulmonary Hypertension: Echocardiographic Evaluation of Pulmonary Hypertension and Right Ventricular Function Irmina Gradus-Pizlo, MD Disclosures: Nothing to disclose Overview Is pulmonary hypertension

More information

Pulmonary hypertension

Pulmonary hypertension Zurich Open Repository and Archive University of Zurich Main Library Strickhofstrasse 39 CH-8057 Zurich www.zora.uzh.ch Year: 2012 Pulmonary hypertension Glaus, T M Posted at the Zurich Open Repository

More information

Multimodality imaging for PAH: Is CT better than MRI?

Multimodality imaging for PAH: Is CT better than MRI? UNIVERSITÀ DEGLI STUDI DI TORINO Facoltà di Medicina e Chirurgia Dipartimento di Scienze Chirurgiche Istituto di Radiologia Azienda Ospedaliera Universitaria Città della Salute e della scienza di Torino

More information

Right Heart Catheterization. Franz R. Eberli MD Chief of Cardiology Stadtspital Triemli, Zurich

Right Heart Catheterization. Franz R. Eberli MD Chief of Cardiology Stadtspital Triemli, Zurich Right Heart Catheterization Franz R. Eberli MD Chief of Cardiology Stadtspital Triemli, Zurich Right Heart Catheterization Pressure measurements Oxygen saturation measurements Cardiac output, Vascular

More information

It has been more than a decade since

It has been more than a decade since doi: 10.1111/j.1751-7133.2010.00192.x R EVIEW P APER Differentiating Pulmonary Arterial and Pulmonary Venous and the Implications for Therapy It has been more than a decade since the Second World Symposium

More information

Cor pulmonale. Dr hamid reza javadi

Cor pulmonale. Dr hamid reza javadi 1 Cor pulmonale Dr hamid reza javadi 2 Definition Cor pulmonale ;pulmonary heart disease; is defined as dilation and hypertrophy of the right ventricle (RV) in response to diseases of the pulmonary vasculature

More information

ino in neonates with cardiac disorders

ino in neonates with cardiac disorders ino in neonates with cardiac disorders Duncan Macrae Paediatric Critical Care Terminology PAP Pulmonary artery pressure PVR Pulmonary vascular resistance PHT Pulmonary hypertension - PAP > 25, PVR >3,

More information

HEMODYNAMIC ASSESSMENT

HEMODYNAMIC ASSESSMENT HEMODYNAMIC ASSESSMENT INTRODUCTION Conventionally hemodynamics were obtained by cardiac catheterization. It is possible to determine the same by echocardiography. Methods M-mode & 2D echo alone can provide

More information

Fig.1 Normal appearance of RV in SAX:

Fig.1 Normal appearance of RV in SAX: Tutorial 7 - Assessment of the right heart Assessment of the Right heart The right heart assessment clinically and echocardiographically is not a very important part of mainstream cardiology. In the ICU,

More information

USE OF INHALED NITRIC OXIDE IN THE NICU East Bay Newborn Specialists Guideline Prepared by P Joe, G Dudell, A D Harlingue Revised 7/9/2014

USE OF INHALED NITRIC OXIDE IN THE NICU East Bay Newborn Specialists Guideline Prepared by P Joe, G Dudell, A D Harlingue Revised 7/9/2014 USE OF INHALED NITRIC OXIDE IN THE NICU East Bay Newborn Specialists Guideline Prepared by P Joe, G Dudell, A D Harlingue Revised 7/9/2014 ino for Late Preterm and Term Infants with Severe PPHN Background:

More information

The World Health Organization (WHO) has classified pulmonary hypertension into five different groups: (2)

The World Health Organization (WHO) has classified pulmonary hypertension into five different groups: (2) Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.40.16 Subject: Letairis Page: 1 of 6 Last Review Date: June 24, 2016 Letairis Description Letairis (ambrisentan)

More information

5.8 Congenital Heart Disease

5.8 Congenital Heart Disease 5.8 Congenital Heart Disease Congenital heart diseases (CHD) refer to structural or functional heart diseases, which are present at birth. Some of these lesions may be discovered later. prevalence of Chd

More information

Comprehensive Hemodynamics By Doppler Echocardiography. The Echocardiographic Swan-Ganz Catheter.

Comprehensive Hemodynamics By Doppler Echocardiography. The Echocardiographic Swan-Ganz Catheter. Comprehensive Hemodynamics By Doppler Echocardiography. The Echocardiographic Swan-Ganz Catheter. Itzhak Kronzon, MD, FASE, FACC, FESC, FAHA, FACP, FCCP North Shore HS, LIJ/Lenox Hill Hospital, New York

More information

1

1 1 2 3 RIFAI 5 6 Dublin cohort, retrospective review. Milrinone was commenced at an initial dose of 0.50 μg/kg/minute up to 0.75 μg/kg/minute and was continued depending on clinical response. No loading

More information

Disclosure. RV is not the innocent bystander 10/1/16. Assessment and Management of Pulmonary Heart Disease in the Female Patient

Disclosure. RV is not the innocent bystander 10/1/16. Assessment and Management of Pulmonary Heart Disease in the Female Patient Assessment and Management of Pulmonary Heart Disease in the Female Patient Oct 1, 2016 Deborah Women s Heart Center Susan E Wiegers, MD, FASE, FACC Professor of Medicine Senior Associate Dean of Faculty

More information

Acute Vasodilator Testing in Pulmonary Hypertension: What, When, and How?

Acute Vasodilator Testing in Pulmonary Hypertension: What, When, and How? Acute Vasodilator Testing in Pulmonary Hypertension: What, When, and How? Teresa De Marco, MD University of California, San Francisco Disclosures: Grants/Research: United Therapeutics, Lung Biotechnology,

More information

Critical Heart Disease in the Newborn. What you need to know

Critical Heart Disease in the Newborn. What you need to know Critical Heart Disease in the Newborn What you need to know DISCLOSURES Nothing to report OBJECTIVES DESCRIBE NEONATAL CARDIOVASCULAR PHYSIOLOGY RECOGNIZE NEONATAL CARDIAC EMERGENCIES FORMULATE TREATMENT

More information

The World Health Organization (WHO) has classified pulmonary hypertension into five different groups: (2)

The World Health Organization (WHO) has classified pulmonary hypertension into five different groups: (2) Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Subject: Tracleer Page: 1 of 6 Last Review Date: September 15, 2017 Tracleer Description Tracleer (bosentan)

More information

Screening for Critical Congenital Heart Disease

Screening for Critical Congenital Heart Disease Screening for Critical Congenital Heart Disease Caroline K. Lee, MD Pediatric Cardiology Disclosures I have no relevant financial relationships or conflicts of interest 1 Most Common Birth Defect Most

More information

The Epidemiology of At Risk groups for Pediatric PH. The Epidemiology of At Risk groups for Pediatric PH. Disclosures

The Epidemiology of At Risk groups for Pediatric PH. The Epidemiology of At Risk groups for Pediatric PH. Disclosures The Epidemiology of At Risk groups for Pediatric PH R.M.F. Berger Disclosures The has received fees for advisory board and steering committee activities of Prof. Berger from: - Actelion, - Bayer, - Glaxo-Smith-Kline,

More information

How to Recognize a Suspected Cardiac Defect in the Neonate

How to Recognize a Suspected Cardiac Defect in the Neonate Neonatal Nursing Education Brief: How to Recognize a Suspected Cardiac Defect in the Neonate https://www.seattlechildrens.org/healthcareprofessionals/education/continuing-medical-nursing-education/neonatalnursing-education-briefs/

More information

Paediatric Cardiology. Acyanotic CHD. Prof F F Takawira

Paediatric Cardiology. Acyanotic CHD. Prof F F Takawira Paediatric Cardiology Acyanotic CHD Prof F F Takawira Aetiology Chromosomal Down syndrome, T13, T18 Genetic syndromes (gene defects) Velo-Cardio-facial (22 del) Genetic syndromes (undefined aetiology)

More information

Pulmonary vascular remodelling: causes, mechanisms and consequences

Pulmonary vascular remodelling: causes, mechanisms and consequences Pulmonary vascular remodelling: causes, mechanisms and consequences Ralph Schermuly Department of Pulmonary Pharmacotherapy University of Giessen and Marburg Lung Center email: ralph.schermuly@ugmlc.de

More information

HISTORY. Question: What category of heart disease is suggested by the fact that a murmur was heard at birth?

HISTORY. Question: What category of heart disease is suggested by the fact that a murmur was heard at birth? HISTORY 23-year-old man. CHIEF COMPLAINT: Decreasing exercise tolerance of several years duration. PRESENT ILLNESS: The patient is the product of an uncomplicated term pregnancy. A heart murmur was discovered

More information

ECHOCARDIOGRAPHIC APPROACH TO CONGENITAL HEART DISEASE: THE UNOPERATED ADULT

ECHOCARDIOGRAPHIC APPROACH TO CONGENITAL HEART DISEASE: THE UNOPERATED ADULT ECHOCARDIOGRAPHIC APPROACH TO CONGENITAL HEART DISEASE: THE UNOPERATED ADULT Karen Stout, MD, FACC Divisions of Cardiology University of Washington Medical Center Seattle Children s Hospital NO DISCLOSURES

More information

Sinus venosus atrial septal defect in a 31- year-old female patient: a case for surgical repair

Sinus venosus atrial septal defect in a 31- year-old female patient: a case for surgical repair Eur Respir Rev 2010; 19: 118, 340 344 DOI: 10.1183/09059180.00007610 CopyrightßERS 2010 CASE REPORT Sinus venosus atrial septal defect in a 31- year-old female patient: a case for surgical repair M.A.

More information

The Hemodynamics of PH Interpreting the numbers

The Hemodynamics of PH Interpreting the numbers The Hemodynamics of PH Interpreting the numbers Todd M Bull MD Associate Professor of Medicine Division of Pulmonary Sciences and Critical Care Medicine Pulmonary Hypertension Center University of Colorado

More information

When is Risky to Apply Oxygen for Congenital Heart Disease 부천세종병원 소아청소년과최은영

When is Risky to Apply Oxygen for Congenital Heart Disease 부천세종병원 소아청소년과최은영 When is Risky to Apply Oxygen for Congenital Heart Disease 부천세종병원 소아청소년과최은영 The Korean Society of Cardiology COI Disclosure Eun-Young Choi The author have no financial conflicts of interest to disclose

More information

2) VSD & PDA - Dr. Aso

2) VSD & PDA - Dr. Aso 2) VSD & PDA - Dr. Aso Ventricular Septal Defect (VSD) Most common cardiac malformation 25-30 % Types of VSD: According to position perimembranous, inlet, muscular. According to size small, medium, large.

More information

Pulmonary arterial hypertension. Pulmonary arterial hypertension: newer therapies. Definition of PH 12/18/16. WHO Group classification of PH

Pulmonary arterial hypertension. Pulmonary arterial hypertension: newer therapies. Definition of PH 12/18/16. WHO Group classification of PH Pulmonary arterial hypertension Pulmonary arterial hypertension: newer therapies Ramona L. Doyle, MD Clinical Professor of Medicine, UCSF Attending Physician UCSF PH Clinic Definition and classification

More information

Patent ductus arteriosus PDA

Patent ductus arteriosus PDA Patent ductus arteriosus PDA Is connecting between the aortic end just distal to the origin of the LT sub clavian artery& the pulmonary artery at its bifurcation. Female/male ratio is 2:1 and it is more

More information

What is the Definition of Small Systemic Ventricle. Hong Ryang Kil, MD Department of Pediatrics, College of Medicine, Chungnam National University

What is the Definition of Small Systemic Ventricle. Hong Ryang Kil, MD Department of Pediatrics, College of Medicine, Chungnam National University What is the Definition of Small Systemic Ventricle Hong Ryang Kil, MD Department of Pediatrics, College of Medicine, Chungnam National University Contents Introduction Aortic valve stenosis Aortic coarctation

More information

Duct Dependant Congenital Heart Disease

Duct Dependant Congenital Heart Disease Children s Acute Transport Service Clinical Guidelines Duct Dependant Congenital Heart Disease This guideline has been agreed by both NTS & CATS Document Control Information Author CATS/NTS Author Position

More information

Right Ventricle Steven J. Lester MD, FACC, FRCP(C), FASE Mayo Clinic, Arizona

Right Ventricle Steven J. Lester MD, FACC, FRCP(C), FASE Mayo Clinic, Arizona Right Ventricle Steven J. Lester MD, FACC, FRCP(C), FASE Mayo Clinic, Arizona 1. In which scenario will applying the simplified Bernoulli equation to the peak tricuspid regurgitation velocity and adding

More information

Echocardiography in Adult Congenital Heart Disease

Echocardiography in Adult Congenital Heart Disease Echocardiography in Adult Congenital Heart Disease Michael Vogel Kinderherz-Praxis München CHD missed in childhood Subsequent lesions after repaired CHD Follow-up of cyanotic heart disease CHD missed in

More information

Cases in Adult Congenital Heart Disease

Cases in Adult Congenital Heart Disease Cases in Adult Congenital Heart Disease Sabrina Phillips, MD FACC FASE Associate Professor of Medicine The University of Oklahoma Health Sciences Center No Disclosures I Have Palpitations 18 Year old Man

More information

Congenital Heart Defects

Congenital Heart Defects Normal Heart Congenital Heart Defects 1. Patent Ductus Arteriosus The ductus arteriosus connects the main pulmonary artery to the aorta. In utero, it allows the blood leaving the right ventricle to bypass

More information

Perioperative Management of TAPVC

Perioperative Management of TAPVC Perioperative Management of TAPVC Professor Andrew Wolf Rush University Medical Center,Chicago USA Bristol Royal Children s Hospital UK I have no financial disclosures relevant to this presentation TAPVC

More information

Pediatric Pulmonary Hypertension: Inside Out

Pediatric Pulmonary Hypertension: Inside Out Pediatric Pulmonary Hypertension: Inside Out Asma Razavi, MD Assistant Professor Pediatric Critical Care Medicine Loma Linda University Children s Hopsital Disclosures I have no conflicts of interest to

More information

The Physiology of the Fetal Cardiovascular System

The Physiology of the Fetal Cardiovascular System The Physiology of the Fetal Cardiovascular System Jeff Vergales, MD, MS Department of Pediatrics Division of Pediatric Cardiology jvergales@virginia.edu Disclosures I serve as the medical director for

More information

Nothing to Disclose. Severe Pulmonary Hypertension

Nothing to Disclose. Severe Pulmonary Hypertension Severe Ronald Pearl, MD, PhD Professor and Chair Department of Anesthesiology Stanford University Rpearl@stanford.edu Nothing to Disclose 65 year old female Elective knee surgery NYHA Class 3 Aortic stenosis

More information

PULMONARY HYPERTENSION

PULMONARY HYPERTENSION PULMONARY HYPERTENSION MARTIN T. MPE CARDIOLOGIST MEDICLINIC HEART HOSPITAL CASE REPORT A 35 year old female, general worker. Married with 2 children with the youngest aged 12 years. Presenting complaints

More information

Pulmonary Hypertension: ICD-10 I27.0, I27.2

Pulmonary Hypertension: ICD-10 I27.0, I27.2 Dr Manish Barman, MD. Membership and Affiliations ESC, European association of cardiovascular prevention and rehabilitation. Acute Cardiovascular Care Association. ESC, Working Group on Hypertension &

More information

Paediatrics Revision Session Cardiology. Emma Walker 7 th May 2016

Paediatrics Revision Session Cardiology. Emma Walker 7 th May 2016 Paediatrics Revision Session Cardiology Emma Walker 7 th May 2016 Cardiovascular Examination! General:! Make it fun!! Change how you act depending on their age! Introduction! Introduce yourself & check

More information

Doppler assessment of pulmonary artery pressure. hyaline membrane disease. and extrapulmonary shunting in the acute phase of ORIGINAL ARTICLES

Doppler assessment of pulmonary artery pressure. hyaline membrane disease. and extrapulmonary shunting in the acute phase of ORIGINAL ARTICLES 6 Archives ofdisease in Childhood 1991; 66: 6-11 ORIGINAL ARTICLES Neonatal Unit, Department of Paediatrics, John Radciiffe Maternity Hospital, Oxford N J Evans L N J Archer Correspondence to: Dr N J Evans,

More information

The Blue Baby. Network Stabilisation of the Term Infant Study Day 15 th March 2017 Joanna Behrsin

The Blue Baby. Network Stabilisation of the Term Infant Study Day 15 th March 2017 Joanna Behrsin The Blue Baby Network Stabilisation of the Term Infant Study Day 15 th March 2017 Joanna Behrsin Session Structure Definitions and assessment of cyanosis Causes of blue baby Structured approach to assessing

More information

Acute Right Ventricular Failure

Acute Right Ventricular Failure Acute Right Ventricular Failure Stavros V. Konstantinides, MD, PhD, FESC Professor, Clinical Trials in Antithrombotic Therapy, and Medical Director Center for Thrombosis und Hemostasis, University of Mainz,

More information

Anatomy & Physiology

Anatomy & Physiology 1 Anatomy & Physiology Heart is divided into four chambers, two atrias & two ventricles. Atrioventricular valves (tricuspid & mitral) separate the atria from ventricles. they open & close to control flow

More information

By Dickens ATURWANAHO & ORIBA DAN LANGOYA MAKchs, MBchB CONGENTAL HEART DISEASE

By Dickens ATURWANAHO & ORIBA DAN LANGOYA MAKchs, MBchB CONGENTAL HEART DISEASE By Dickens ATURWANAHO & ORIBA DAN LANGOYA MAKchs, MBchB CONGENTAL HEART DISEASE Introduction CHDs are abnormalities of the heart or great vessels that are present at birth. Common type of heart disease

More information

Pulmonary Arterial Hypertension - Overview

Pulmonary Arterial Hypertension - Overview Pulmonary Arterial Hypertension - Overview J. Shaun Smith, MD Co-Director, Pulmonary Vascular Disease Program Assistant Professor of Medicine Division of Pulmonary, Critical Care and Sleep Medicine The

More information

Pulmonary Arterial Hypertension - Overview

Pulmonary Arterial Hypertension - Overview Pulmonary Arterial Hypertension - Overview J. Shaun Smith, MD Co-Director, Pulmonary Vascular Disease Program Assistant Professor of Medicine Division of Pulmonary, Critical Care and Sleep Medicine The

More information

Data Collected: June 17, Reported: June 30, Survey Dates 05/24/ /07/2010

Data Collected: June 17, Reported: June 30, Survey Dates 05/24/ /07/2010 Job Task Analysis for ARDMS Pediatric Echocardiography Data Collected: June 17, 2010 Reported: Analysis Summary For: Pediatric Echocardiography Exam Survey Dates 05/24/2010-06/07/2010 Invited Respondents

More information

Pediatric Echocardiography Examination Content Outline

Pediatric Echocardiography Examination Content Outline Pediatric Echocardiography Examination Content Outline (Outline Summary) # Domain Subdomain Percentage 1 Anatomy and Physiology Normal Anatomy and Physiology 10% 2 Abnormal Pathology and Pathophysiology

More information

Congenital heart disease. By Dr Saima Ali Professor of pediatrics

Congenital heart disease. By Dr Saima Ali Professor of pediatrics Congenital heart disease By Dr Saima Ali Professor of pediatrics What is the most striking clinical finding in this child? Learning objectives By the end of this lecture, final year student should be able

More information

Introduction. Pediatric Cardiology. General Appearance. Tools of Assessment. Auscultation. Vital Signs

Introduction. Pediatric Cardiology. General Appearance. Tools of Assessment. Auscultation. Vital Signs Introduction Pediatric Cardiology An introduction to the pediatric patient with heart disease: M-III Lecture Douglas R. Allen, M.D. Assistant Professor and Director of Community Pediatric Cardiology at

More information

Pulmonary Hypertension. Echocardiography: Pearls & Pitfalls

Pulmonary Hypertension. Echocardiography: Pearls & Pitfalls Pulmonary Hypertension Echocardiography: Pearls & Pitfalls Αθανάσιος Γ. Κουτσάκης Ειδικευόμενος Καρδιολογίας Α Καρδιολογική Κλινική ΑΠΘ Σεμινάρια Ομάδων Εργασίας Ελληνικής Καρδιολογικής Εταιρείας Ιωάννινα,

More information

Neonatal/Pediatric Cardiopulmonary Care. Persistent Pulmonary Hypertension of the Neonate (PPHN) PPHN. Other. Other Diseases

Neonatal/Pediatric Cardiopulmonary Care. Persistent Pulmonary Hypertension of the Neonate (PPHN) PPHN. Other. Other Diseases Neonatal/Pediatric Cardiopulmonary Care Other Diseases Persistent Pulmonary Hypertension of the Neonate (PPHN) PPHN 3 Also known as Persistent Fetal Circulation (PFC) Seen most frequently in term, post-term

More information