Digital subtraction pulmonary angiography (DSPA) is a potentially useful imaging modality for evaluating changes in the pulmonary vasculature of children with pulmonary hypertension (PH) associated with bronchopulmonary dysplasia (BPD), according to study findings published in Medical Sciences (Basel).

Recognizing that BPD is the most common respiratory sequela associated with premature birth, investigators sought to evaluate the pulmonary vasculature of preterm infants undergoing cardiac catheterization for PH in a retrospective pilot study. In each of the 3 newborns, a digital subtraction pulmonary artery angiogram was performed because of its potential benefits of both lower exposure to radiation and the use of a lower dose of radiographic contrast material compared with conventional cineangiography. The procedure was tolerated by all patients and no complications were reported.

Of the 3 infants examined, 2 were born at 22 weeks’ and 1 at 24 weeks’ gestation. PH was diagnosed via echocardiogram in all 3 newborns after birth and was attributed to their chronic lung disease and continued need for respiratory support. Normal renal function was reported in all 3 infants and no adverse events from the contrast medium were observed after the DSPA was analyzed.


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The use of DSPA revealed significant lung perfusion defects in all 3 patients in comparison with DSPA images from a normal child with normal pulmonary artery pressure. Per the study findings, mean pulmonary artery pressure to mean aortic pressure ratios in patients 1, 2, and 3 were 54%, 55%, and 43%, respectively. In a similar fashion, the pulmonary vascular resistance index to systemic vascular index ratios in patients 1, 2, and 3 were 0.36, 0.31, and 0.25, respectively.

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The investigators concluded that although only 3 infants were evaluated in this study, the preliminary data imply that a severe perfusion abnormality is associated with the severity of pulmonary vascular disease in children with BPD. Larger studies are warranted to confirm these findings and help to elucidate the pathophysiologic significance of the alteration of pulmonary vasculature in children with BPD born prematurely and thus assist in management and prognostication.

Reference

Das B, Jadotte M-M, Mills J, Chan K-C. Digital subtraction pulmonary angiography in children with pulmonary hypertension due to bronchopulmonary dysplasia. Med Sci (Basel). 2019;7(2). pii:E26.