Case 1 - Severe PH in BPD

Extreme premature newborn 26+0 weeks who required intubation on day one of life and surfactant was administered. There was incomplete coverage with antenatal betamethasone due to precipitous labour. Baby was extubated to CPAP and remained on CPAP until 36 weeks. Echocardiography at 1 week of life was unremarkable except for the presence of an atrial septal defect that was left to right and a small patent ductus arteriosus (left to right, restrictive and 0.12 cm). A repeat echocardiography was performed 2 weeks later and outlined a closed duct. The patient did not have any other complication throughout the stay.

At the time of the screening, the FiO2 was 25-28% and blood pressure was 65/32. Chest radiography showed signs of BPD. Based on the ECHO results, the patient was started on iNO via high flow nasal cannual and sildenafil. The iNO was weaned two weeks later. Patient was discharged on home oxygen, which were weaned in the first year of life. Sildenafil was weaned a few months later once the RV pressure were estimated to be normal.

Part 1 - Severe and Moderate PH

Targeted Neonatal Echocardiography Review

This is parasternal long axis view. We can appreciate that there is significant RV dilatation on the superior part of the image. There is also hypertrophy of the RV wall and of the septum. We can see the aortic valve opening and closing, and - although this is not the best view to appreciate septal motion, we suspect paradoxical motion of the septum which seems to compress the left ventricle in systole.

Here we apply colour mode - with a velocity filter (Nyquist) of 92.4 cm/s. We can see that there is no significant mitral insufficiency and that there is appropriate blood flow entering the LV through the mitral valve in diastole.

This is a posterior sweep in the PLAX view. We have colour over the inflow of the right ventricle and we can appreciate a blue jet (blood flow going away from the probe) during right ventricular systole. This jet corresponds to tricuspid insufficiency and one can obtain a CW-Doppler through it in order to quantify the velocity gradient between the RV and RA in ventricular systole.

The M-mode cut along RV and LV showed dilated and hypertrophy RV with paradoxical motion of interventricular septum which flatted during LV systole.

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