Skip to main content
NCBI home page
British Heart Journal logoLink to British Heart Journal
. 1983 Dec;50(6):540–549. doi: 10.1136/hrt.50.6.540

Left ventricular function in persistent pulmonary hypertension of the newborn. Computer analysis of the echocardiogram.

M G St John Sutton, R A Meyer
PMCID: PMC481457  PMID: 6651997

Abstract

Regional and global left ventricular function was assessed in 23 neonates with persistent pulmonary hypertension using computer assisted analysis of their left ventricular echocardiograms and compared with that in 50 healthy neonates. End diastolic left ventricular dimension was normal and end systolic dimension increased while percentage left ventricular shortening and peak velocity of circumferential fibre shortening decreased indicating impaired systolic performance. The peak rate of increase in left ventricular diameter in early diastole was significantly decreased and the durations of the rapid filling and isovolumic relaxation periods were prolonged suggesting resistance to left ventricular filling due to changes in diastolic myocardial properties. This abnormal left ventricular cavity function may have been due to a combination of increased diastolic wall thickness, reduced percentage systolic wall thickening, increased relative wall thickness, and pronounced reduction in peak rates of systolic wall thickening and diastolic wall thinning Seven neonates with persistent pulmonary hypertension died, and of the three examined at necropsy all had left ventricular hypertrophy and two extensive subendocardial haemorrhage and infarction affecting the right and left ventricular papillary muscles. Thus left ventricular dysfunction appears to be a common feature in neonates with this disorder and may be readily detected using computer analysis of left ventricular echocardiograms. Unfortunately, no single echo measurement was useful prognostically. Left ventricular dysfunction in persistent pulmonary hypertension probably results from a combination of hypoxaemia, acidaemia, and pulmonary hypertension, and although it may contribute to the high mortality in this syndrome, a correlation between the severity of left ventricular dysfunction and clinical outcome could not be shown.

Full text

PDF
540

Images in this article

541Image
on p.541

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Donnelly W. H., Bucciarelli R. L., Nelson R. M. Ischemic papillary muscle necrosis in stressed newborn infants. J Pediatr. 1980 Feb;96(2):295–300. doi: 10.1016/s0022-3476(80)80833-x. [DOI] [PubMed] [Google Scholar]
  2. Downing S. E., Talner N. S., Gardner T. H. Influences of hypoxemia and acidemia on left ventricular function. Am J Physiol. 1966 Jun;210(6):1327–1334. doi: 10.1152/ajplegacy.1966.210.6.1327. [DOI] [PubMed] [Google Scholar]
  3. EMMANOUILIDES G. C., MOSS A. J., DUFFIE E. R., Jr, ADAMS F. H. PULMONARY ARTERIAL PRESSURE CHANGES IN HUMAN NEWBORN INFANTS FROM BIRTH TO 3 DAYS OF AGE. J Pediatr. 1964 Sep;65:327–333. doi: 10.1016/s0022-3476(64)80395-4. [DOI] [PubMed] [Google Scholar]
  4. ENSON Y., GIUNTINI C., LEWIS M. L., MORRIS T. Q., FERRER M. I., HARVEY R. M. THE INFLUENCE OF HYDROGEN ION CONCENTRATION AND HYPOXIA ON THE PULMONARY CIRCULATION. J Clin Invest. 1964 Jun;43:1146–1162. doi: 10.1172/JCI104999. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Esterly J. R., Oppenheimer E. H. Some aspects of cardiac pathology in infancy and childhood. IV. Myocardial and coronary lesions in cardiac malformations. Pediatrics. 1967 Jun;39(6):896–903. [PubMed] [Google Scholar]
  6. Finley J. P., Howman-Giles R. B., Gilday D. L., Bloom K. R., Rowe R. D. Transient myocardial ischemia of the newborn infant demonstrated by thallium myocardial imaging. J Pediatr. 1979 Feb;94(2):263–270. doi: 10.1016/s0022-3476(79)80841-0. [DOI] [PubMed] [Google Scholar]
  7. Fixler D. E., Archie J. P., Ullyot D. J., Buckberg G. D., Hoffman J. I. Effects of acute right ventricular systolic hypertension on regional myocardial blood flow in anesthetized dogs. Am Heart J. 1973 Apr;85(4):491–500. doi: 10.1016/0002-8703(73)90493-6. [DOI] [PubMed] [Google Scholar]
  8. Franciosi R. A., Blanc W. A. Myocardial infarcts in infants and children. I. A necropsy study in congenital heart disease. J Pediatr. 1968 Sep;73(3):309–319. doi: 10.1016/s0022-3476(68)80106-4. [DOI] [PubMed] [Google Scholar]
  9. Gibson D. G., Brown D. Measurement of instantaneous left ventricular dimension and filling rate in man, using echocardiography. Br Heart J. 1973 Nov;35(11):1141–1149. doi: 10.1136/hrt.35.11.1141. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Gibson D. G., Traill T. A., Hall R. J., Brown D. J. Echocardiographic features of secondary left ventricular hypertrophy. Br Heart J. 1979 Jan;41(1):54–59. doi: 10.1136/hrt.41.1.54. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Krayenbuehl H. P., Turina J., Hess O. Left ventricular function in chronic pulmonary hypertension. Am J Cardiol. 1978 Jun;41(7):1150–1158. doi: 10.1016/0002-9149(78)90872-x. [DOI] [PubMed] [Google Scholar]
  12. Levin D. L., Heymann M. A., Kitterman J. A., Gregory G. A., Phibbs R. H., Rudolph A. M. Persistent pulmonary hypertension of the newborn infant. J Pediatr. 1976 Oct;89(4):626–630. doi: 10.1016/s0022-3476(76)80405-2. [DOI] [PubMed] [Google Scholar]
  13. McLaurin L. P., Gibson T. C., Waider W., Grossman W., Craige E. An appraisal of mitral valve echocardiograms mimicking mitral stenosis in conditions with right ventricular pressure overload. Circulation. 1973 Oct;48(4):801–809. doi: 10.1161/01.cir.48.4.801. [DOI] [PubMed] [Google Scholar]
  14. Mehran-Pour M., Hirschfeld S., Francioli M., Liebman J. Left ventricular myocardial infarction in tetralogy of Fallot. Am J Dis Child. 1978 Dec;132(12):1217–1218. doi: 10.1001/archpedi.1978.02120370069019. [DOI] [PubMed] [Google Scholar]
  15. Milstein J. M., Goetzman B. W., Riemenschneider T. A., Wennberg R. P. Increased systemic vascular resistance in neonates with pulmonary hypertension. Am J Cardiol. 1979 Nov;44(6):1159–1162. doi: 10.1016/0002-9149(79)90182-6. [DOI] [PubMed] [Google Scholar]
  16. NAEYE R. L., LETTS H. W. The effects of prolonged neonatal hypoxemia on the pulmonary vascular bed and heart. Pediatrics. 1962 Dec;30:902–908. [PubMed] [Google Scholar]
  17. RUDOLPH A. M., AULD P. A., GOLINKO R. J., PAUL M. H. Pulmonary vascular adjustments in the neonatal period. Pediatrics. 1961 Jul;28:28–34. [PubMed] [Google Scholar]
  18. Riemenscneider T. A., Nielsen H. C., Ruttenberg H. D., Jaffe R. B. Disturbances of the transitional circulation: spectrum of pulmonary hypertension and myocardial dysfunction. J Pediatr. 1976 Oct;89(4):622–625. doi: 10.1016/s0022-3476(76)80404-0. [DOI] [PubMed] [Google Scholar]
  19. Riggs T., Hirschfeld S., Fanaroff A., Liebman J., Fletcher B., Meyer R. Persistence of fetal circulation syndrome: an echocardiographic study. J Pediatr. 1977 Oct;91(4):626–631. doi: 10.1016/s0022-3476(77)80521-0. [DOI] [PubMed] [Google Scholar]
  20. Rowe R. D., Hoffman T. Transient myocardial ischemia of the newborn infant: a form of severe cardiorespiratory distress in full-term infants. J Pediatr. 1972 Aug;81(2):243–250. doi: 10.1016/s0022-3476(72)80290-7. [DOI] [PubMed] [Google Scholar]
  21. Rudolph A. M., Yuan S. Response of the pulmonary vasculature to hypoxia and H+ ion concentration changes. J Clin Invest. 1966 Mar;45(3):399–411. doi: 10.1172/JCI105355. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Setzer E., Ermocilla R., Tonkin I., John E., Sansa M., Cassady G. Papillary muscle necrosis in a neonatal autopsy population: incidence and associated clinical manifestations. J Pediatr. 1980 Feb;96(2):289–294. doi: 10.1016/s0022-3476(80)80832-8. [DOI] [PubMed] [Google Scholar]
  23. Siassi B., Goldberg S. J., Emmanouilides G. C., Higashino S. M., Lewis E. Persistent pulmonary vascular obstruction in newborn infants. J Pediatr. 1971 Apr;78(4):610–615. doi: 10.1016/s0022-3476(71)80462-6. [DOI] [PubMed] [Google Scholar]
  24. St John Sutton M. G., Hagler D. J., Tajik A. J., Giuliani E. R., Seward J. B., Ritter D. G., Ritman E. L. Cardiac function in the normal newborn: additional information by computer analysis of the M-mode echocardiogram. Circulation. 1978 Jun;57(6):1198–1204. doi: 10.1161/01.cir.57.6.1198. [DOI] [PubMed] [Google Scholar]
  25. St John Sutton M. G., Marier D. L., Oldershaw P. J., Sacchetti R., Gibson D. G. Effect of age related changes in chamber size, wall thickness, and heart rate on left ventricular function in normal children. Br Heart J. 1982 Oct;48(4):342–351. doi: 10.1136/hrt.48.4.342. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. St John Sutton M. G., Tajik A. J., Mercier L. A., Seward J. B., Giuliani E. R., Ritman E. L. Assessment of left ventricular function in secundum atrial septal defect by computer analysis of the M-mode echocardiogram. Circulation. 1979 Nov;60(5):1082–1090. doi: 10.1161/01.cir.60.5.1082. [DOI] [PubMed] [Google Scholar]
  27. Sutton M. G., Tajik A. J., Gibson D. G., Brown D. J., Seward J. B., Guiliani E. R. Echocardiographic assessment of left ventricular filling and septal and posterior wall dynamics in idiopathic hypertrophic subaortic stenosis. Circulation. 1978 Mar;57(3):512–520. doi: 10.1161/01.cir.57.3.512. [DOI] [PubMed] [Google Scholar]
  28. de Boer A. C., Turpie A. G., Butt R. W., Johnston R. V., Genton E. Platelet release and thromboxane synthesis in symptomatic coronary artery disease. Circulation. 1982 Aug;66(2):327–333. doi: 10.1161/01.cir.66.2.327. [DOI] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES