The Impact of Atrial Left-to-Right Shunt on Pulmonary Hypertension in Preterm Infants with Moderate or Severe Bronchopulmonary Dysplasia.
BACKGROUND
Bronchopulmonary dysplasia (BPD)-associated pulmonary hypertension (PH) is a well-known complication of prematurity; however, the additional impact of a left-to-right interatrial shunt on this condition remains poorly understood. The aim of the present study was to identify the significance of atrial left-to-right shunt lesions in PH infants with moderate or severe BPD.


METHODS
The medical records of 383 preterm infants (gestational age of < 32 weeks) who were diagnosed with BPD between 2005 and 2013 were retrospectively reviewed. Baseline characteristics such as interatrial shunts and outcomes were compared between the infants who developed PH (n = 50) and infants who did not (n = 144). Infants with hemodynamically significant residual patent ductus arteriosus were excluded. Among the infants diagnosed with PH (n = 50), the outcomes were compared between the patients with (n = 21) and without atrial shunts (n = 29) at 36 weeks corrected postmenstrual age.


RESULTS
Fifty (15%) preterm infants with BPD were diagnosed with PH. The number of infants with a history of atrial shunt lesions was significantly higher in the PH group than in the non-PH group (42% vs. 15.3%, respectively). The adjusted odds ratio for PH in the atrial shunt group was 3.8 (95% confidence interval, 1.8-8.0), compared to PH-BPD infants without an atrial shunt.


CONCLUSIONS
The presence of an atrial left-to-right shunt was associated with PH in preterm infants with moderate or severe BPD. Close follow up is needed for infants with interatrial shunts, and a more tailored prognostic evaluation and treatment are recommended.
Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea.
Eui Kyung
EK
Choi
Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea.
Young Hwa
YH
Jung
Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea. Electronic address: kimhans@snu.ac.kr.
Han-Suk
HS
Kim
Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea.
Seung Han
SH
Shin
Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea.
Chang Won
CW
Choi
Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea.
Ee-Kyung
EK
Kim
Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea.
Beyong Il
BI
Kim
Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea.
Jung-Hwan
JH
Choi
D001997:Bronchopulmonary Dysplasia / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology*; D005260:Female; D005865:Gestational Age; D006801:Humans; D006976:Hypertension, Pulmonary / Q000453:epidemiology* / Q000503:physiopathology*; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000503:physiopathology*; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies
atrial septal defect; bronchopulmonary dysplasia; congenital heart disease; premature infant; pulmonary hypertension