Pulmonary hypertension in bronchopulmonary dysplasia.

Biomarkers / blood Bronchopulmonary Dysplasia / complications Cardiac Catheterization Cardiac Surgical Procedures Echocardiography Endothelin Receptor Antagonists / therapeutic use Heart Failure / etiology Humans Hypertension, Pulmonary / drug therapy Infant, Newborn Infant, Premature Infant, Premature, Diseases / physiopathology Magnetic Resonance Imaging Nitric Oxide / metabolism Oxygen Inhalation Therapy Prostaglandins I / therapeutic use Sildenafil Citrate / therapeutic use Tomography, X-Ray Computed Tricuspid Valve Insufficiency / diagnostic imaging Vascular Resistance Vasodilator Agents / therapeutic use

Journal

Pediatric research
ISSN: 1530-0447
Titre abrégé: Pediatr Res
Pays: United States
ID NLM: 0100714

Informations de publication

Date de publication:
02 2021
Historique:
received: 04 03 2020
accepted: 12 05 2020
revised: 24 04 2020
pubmed: 11 6 2020
medline: 11 1 2022
entrez: 11 6 2020
Statut: ppublish

Résumé

Bronchopulmonary dysplasia (BPD) is a major complication in prematurely born infants. Pulmonary hypertension (PH) associated with BPD (BPD-PH) is characterized by alveolar diffusion impairment, abnormal vascular remodeling, and rarefication of pulmonary vessels (vascular growth arrest), which lead to increased pulmonary vascular resistance and right heart failure. About 25% of infants with moderate to severe BPD develop BPD-PH that is associated with high morbidity and mortality. The recent evolution of broader PH-targeted pharmacotherapy in adults has opened up new treatment options for infants with BPD-PH. Sildenafil became the mainstay of contemporary BPD-PH therapy. Additional medications, such as endothelin receptor antagonists and prostacyclin analogs/mimetics, are increasingly being investigated in infants with PH. However, pediatric data from prospective or randomized controlled trials are still sparse. We discuss comprehensive diagnostic and therapeutic strategies for BPD-PH and briefly review the relevant differential diagnoses of parenchymal and interstitial developmental lung diseases. In addition, we provide a practical framework for the management of children with BPD-PH, incorporating the modified definition and classification of pediatric PH from the 2018 World Symposium on Pulmonary Hypertension, and the 2019 EPPVDN consensus recommendations on established and newly developed therapeutic strategies. Finally, current gaps of knowledge and future research directions are discussed. IMPACT: PH in BPD substantially increases mortality. Treatment of BPD-PH should be conducted by an interdisciplinary team and follow our new treatment algorithm while still kept tailored to the individual patient. We discuss recent developments in BPD-PH, make recommendations on diagnosis, monitoring and treatment of PH in BPD, and address current gaps of knowledge and potential research directions. We provide a practical framework, including a new treatment algorithm, for the management of children with BPD-PH, incorporating the modified definition and classification of pediatric PH (2018 WSPH) and the 2019 EPPVDN consensus recommendations on established and newly developed therapeutic strategies for BPD-PH.

Identifiants

DOI: 10.1038/s41390-020-0993-4 PMID: 32521539 PMC: PMC7979539
pubmed: 32521539
doi: 10.1038/s41390-020-0993-4
pii: 10.1038/s41390-020-0993-4
pmc: PMC7979539
doi:

Substances chimiques

Biomarkers 0
Endothelin Receptor Antagonists 0
Prostaglandins I 0
Vasodilator Agents 0
Nitric Oxide 31C4KY9ESH
Sildenafil Citrate BW9B0ZE037

Types de publication

Journal Article Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

446-455

Subventions

Organisme : NHLBI NIH HHS
ID : R01 HL055454
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL146128
Pays : United States

Références

Stoll, B. J. et al. Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993–2012. JAMA 314, 1039–1051 (2015).
pubmed: 26348753 pmcid: 26348753
Lignelli, E., Palumbo, F., Myti, D. & Morty, R. E. Recent advances in our understanding of the mechanisms of lung alveolarization and bronchopulmonary dysplasia. Am. J. Physiol. Lung Cell. Mol. Physiol. 317, L832–L887 (2019).
pubmed: 31596603
Weismann, C. G. et al. Pulmonary hypertension in preterm infants: results of a prospective screening program. J. Perinatol. 37, 572–577 (2017).
pubmed: 28206997
Mourani, P. M. et al. Early pulmonary vascular disease in preterm infants at risk for bronchopulmonary dysplasia. Am. J. Respir. Crit. Care Med. 191, 87–95 (2015).
pubmed: 25389562 pmcid: 4299632
Khemani, E. et al. Pulmonary artery hypertension in formerly premature infants with bronchopulmonary dysplasia: clinical features and outcomes in the surfactant era. Pediatrics 120, 1260–1269 (2007).
pubmed: 18055675
Altit, G., Bhombal. S., Feinstein, J., Hopper, R. K. & Tacy, T. A. Diminished right ventricular function at diagnosis of pulmonary hypertension is associated with mortality in bronchopulmonary dysplasia. Pulm. Circ. 9, 2045894019878598 (2019).
Ong, M. S. et al. Racial and ethnic differences in pediatric pulmonary hypertension: an analysis of the Pediatric Pulmonary Hypertension Network Registry. J. Pediatr. 211, 63–71.e6 (2019).
pubmed: 31176455 pmcid: 6776463
Nakanishi, H., Uchiyama, A. & Kusuda, S. Impact of pulmonary hypertension on neurodevelopmental outcome in preterm infants with bronchopulmonary dysplasia: a cohort study. J. Perinatol. 36, 890–896 (2016).
pubmed: 27442157 pmcid: 5050265
Choi, E. K., Shin, S. H., Kim, E. K. & Kim, H. S. Developmental outcomes of preterm infants with bronchopulmonary dysplasia-associated pulmonary hypertension at 18-24 months of corrected age. BMC Pediatr. 19, 26 (2019).
pubmed: 30654786 pmcid: 6337852
Lagatta, J. M. et al. The impact of pulmonary hypertension in preterm infants with severe bronchopulmonary dysplasia through 1 year. J. Pediatr. 203, 218–224.e3 (2018).
pubmed: 30172426 pmcid: 6460906
Goss, K. N. et al. Early pulmonary vascular disease in young adults born preterm. Am. J. Respir. Crit. Care Med. 198, 1549–1558 (2018).
pubmed: 29944842 pmcid: 6298636
Hansmann, G. et al. 2019 updated consensus statement on the diagnosis and treatment of pediatric pulmonary hypertension: The European Pediatric Pulmonary Vascular Disease Network (EPPVDN), endorsed by AEPC, ESPR and ISHLT. J. Heart Lung Transplant. 38, 879–901 (2019).
pubmed: 31495407
Rosenzweig, E. B. et al. Paediatric pulmonary arterial hypertension: updates on definition, classification, diagnostics and management. Eur. Respir. J. 53, 1801916 (2019).
pubmed: 30545978 pmcid: 6351335
Galie, N. et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur. Heart J. 37, 67–119 (2016).
pubmed: 26320113
Simonneau, G. et al. Haemodynamic definitions and updated clinical classification of pulmonary hypertension. Eur. Respir. J. 53, 1801913 (2019).
pubmed: 30545968 pmcid: 6351336
Douschan, P. et al. Mild elevation of pulmonary arterial pressure as a predictor of mortality. Am. J. Respir. Crit. Care Med. 197, 509–516 (2018).
pubmed: 29099619
Cerro, M. J. et al. A consensus approach to the classification of pediatric pulmonary hypertensive vascular disease: report from the PVRI Pediatric Taskforce, Panama 2011. Pulm. Circ. 1, 286–298 (2011).
pubmed: 21874158 pmcid: 3161725
Sallmon, H. et al. Recommendations from the Association for European Paediatric and Congenital Cardiology for training in pulmonary hypertension. Cardiol. Young. 29, 1323–1327 (2019).
pubmed: 31554525
Duijts, L. et al. European Respiratory Society guideline on long term management of children with bronchopulmonary dysplasia. Eur. Respir. J. 55, 1900788 (2020).
pubmed: 31558663
Calvier, L. et al. PPARγ links BMP2 and TGFβ1 pathways in vascular smooth muscle cells, regulating cell proliferation and glucose metabolism. Cell. Metab. 25, 1118–1134.e7 (2017).
pubmed: 28467929
Thébaud, B. et al. Bronchopulmonary dysplasia. Nat. Rev. Dis. Prim. 5, 78 (2019).
pubmed: 31727986
Jobe, A. H. & Bancalari, E. Bronchopulmonary dysplasia. Am. J. Respir. Crit. Care Med. 163, 1723–1729 (2001).
pubmed: 11401896
Jensen, E. A. et al. The diagnosis of bronchopulmonary dysplasia in very preterm infants. An evidence-based approach. Am. J. Respir. Crit. Care Med. 200, 751–759 (2019).
pubmed: 30995069 pmcid: 6775872
Ploegstra, M. J. et al. Echocardiography in pediatric pulmonary arterial hypertension: early study on assessing disease severity and predicting outcome. Circ. Cardiovasc. Imaging 8, e000878 (2015).
pubmed: 25552488
Koestenberger, M. et al. Echocardiographic reference values for right atrial size in children with and without atrial septal defects or pulmonary hypertension. Pediatr. Cardiol. 37, 686–695 (2016).
pubmed: 26706469
Burkett, D. A. et al. Impact of pulmonary hemodynamics and ventricular interdependence on left ventricular diastolic function in children with pulmonary hypertension. Circ. Cardiovasc. Imaging 9, e004612 (2016).
pubmed: 27581953
Hansmann, G. Left ventricular diastolic dysfunction in pediatric pulmonary hypertension. Circ. Cardiovasc. Imaging 9, e005527 (2016).
pubmed: 27581954
Nawaytou, H. et al. Clinical utility of echocardiography in former preterm infants with bronchopulmonary dysplasia. J. Am. Soc. Echocardiogr. 33, 378–388.e1 (2020).
pubmed: 31948712
Rajaram, S. et al. 3D contrast-enhanced lung perfusion MRI is an effective screening tool for chronic thromboembolic pulmonary hypertension: results from the ASPIRE Registry. Thorax 68, 677–678 (2013).
pubmed: 23349220
Schoenfeld, C. et al. MR imaging-derived regional pulmonary parenchymal perfusion and cardiac function for monitoring patients with chronic thromboembolic pulmonary hypertension before and after pulmonary endarterectomy. Radiology 279, 925–934 (2016).
pubmed: 26727392
Critser, P. J. et al. Cardiac magnetic resonance imaging evaluation of neonatal bronchopulmonary dysplasia-associated pulmonary hypertension. Am. J. Respir. Crit. Care Med. 201, 73–82 (2020).
pubmed: 31539272 pmcid: 6938152
Kato, S. et al. Prognostic value of cardiovascular magnetic resonance derived right ventricular function in patients with interstitial lung disease. J. Cardiovasc. Magn. Reson. 17, 10 (2015).
pubmed: 25871501 pmcid: 4323037
Steurer, M. A. et al. Mortality in infants with bronchopulmonary dysplasia: data from cardiac catheterization. Pediatr. Pulmonol. 54, 804–813 (2019).
pubmed: 30938937
Ploegstra, M. J. et al. Growth in children with pulmonary arterial hypertension: a longitudinal retrospective multiregistry study. Lancet Respir. Med. 4, 281–290 (2016).
pubmed: 26994897
Frank, B. S. et al. Acute vasoreactivity testing during cardiac catheterization of neonates with bronchopulmonary dysplasia-associated pulmonary hypertension. J. Pediatr. 208, 127–133 (2019).
pubmed: 30871795
Ploegstra, M. J., Zijlstra, W. M., Douwes, J. M., Hillege, H. L. & Berger, R. M. Prognostic factors in pediatric pulmonary arterial hypertension: a systematic review and meta-analysis. Int. J. Cardiol. 184, 198–207 (2015).
pubmed: 25706327
Nir, A. et al. NT-pro-B-type natriuretic peptide in infants and children: reference values based on combined data from four studies. Pediatr. Cardiol. 30, 3–8 (2009).
pubmed: 18600369
Rodríguez-Blanco, S. et al. N-terminal-probrain natriuretic peptide as a biomarker of moderate to severe bronchopulmonary dysplasia in preterm infants: a prospective observational study. Pediatr. Pulmonol. 53, 1073–1081 (2018).
pubmed: 29790673
Zhou, L. et al. N-terminal Pro-B-type natriuretic peptide as a biomarker of bronchopulmonary dysplasia or death in preterm infants: a retrospective cohort analysis. Front. Pediatr. 7, 166 (2019).
pubmed: 31134166 pmcid: 6524726
Montgomery, A. M. et al. Biochemical screening for pulmonary hypertension in preterm infants with bronchopulmonary dysplasia. Neonatology 109, 190–194 (2016).
pubmed: 26780635
Cohen, J. L. et al. Sildenafil use in children with pulmonary hypertension. J. Pediatr. 205, 29–34.e1 (2019).
pubmed: 30396684
Kadmon, G. et al. Pulmonary hypertension specific treatment in infants with bronchopulmonary dysplasia. Pediatr. Pulmonol. 52, 77–83 (2017).
pubmed: 27333438
Hansmann, G., Meinel, K., Bukova, M., Chouvarine, P., Wåhlander, H. & Koestenberger, M.; European Pediatric Pulmonary Vascular Disease Network (EPPVDN). Selexipag for the Treatment of Children With Pulmonary Arterial Hypertension: First Multicenter Experience in Drug Safety and Efficacy. J. Heart Lung Transplant. (2020). https://doi.org/10.1016/j.healun.2020.03.029 . [Online ahead of print].
Schweintzger, S. et al. Safety and efficacy of the endothelin receptor antagonist macitentan in pediatric pulmonary hypertension. Cardiovasc. Diagn. Ther. https://doi.org/10.21037/cdt.2020.04.01 (2020).
doi: 10.21037/cdt.2020.04.01 pubmed: 33224780 pmcid: 7666951
Mourani, P. M., Sontag, M. K., Ivy, D. D. & Abman, S. H. Effects of long-term sildenafil treatment for pulmonary hypertension in infants with chronic lung disease. J. Pediatr. 154, 379–384 (2009).
pubmed: 18950791
Lakshminrusimha, S., Mathew, B. & Leach, C. L. Pharmacologic strategies in neonatal pulmonary hypertension other than nitric oxide. Semin. Perinatol. 40, 160–173 (2016).
pubmed: 26778236 pmcid: 4808469
Ghofrani, H. A. et al. Riociguat for the treatment of pulmonary arterial hypertension. N. Engl. J. Med. 369, 330–340 (2013).
pubmed: 23883378
Abman, S. H. et al. Pediatric pulmonary hypertension: guidelines from the American Heart Association and American Thoracic Society. Circulation 132, 2037–2099 (2015).
pubmed: 26534956
Krishnan, U. et al. Evaluation and management of pulmonary hypertension in children with bronchopulmonary dysplasia. J. Pediatr. 188, 24–34.e1 (2017).
pubmed: 28645441
Tzoumas, N., Farrah, T. E., Dhaun, N. & Webb, D. J. Established and emerging therapeutic uses of phosphodiesterase type 5 inhibitors in cardiovascular disease. Br. J. Pharmacol. https://doi.org/10.1111/bph.14920 (2019).
Barst, R. J. et al. STARTS-2: long-term survival with oral sildenafil monotherapy in treatment-naive pediatric pulmonary arterial hypertension. Circulation 129, 1914–1923 (2014).
pubmed: 24637559
Rosenzweig, E. B. et al. Effects of long-term bosentan in children with pulmonary arterial hypertension. J. Am. Coll. Cardiol. 46, 697–704 (2005).
pubmed: 16098438
Barst, R. J. et al. Pharmacokinetics, safety, and efficacy of bosentan in pediatric patients with pulmonary arterial hypertension. Clin. Pharmacol. Ther. 73, 372–382 (2003).
pubmed: 12709727
Beghetti, M. et al. Pharmacokinetic and clinical profile of a novel formulation of bosentan in children with pulmonary arterial hypertension: the FUTURE-1 study. Br. J. Clin. Pharmacol. 68, 948–955 (2009).
pubmed: 20002090 pmcid: 2805863
Berger, R. M. et al. FUTURE-2: results from an open-label, long-term safety and tolerability extension study using the pediatric FormUlation of bosenTan in pUlmonary arterial hypeRtEnsion. Int. J. Cardiol. 202, 52–58 (2016).
pubmed: 26386921
Koestenberger, M. et al. Ventricular–ventricular interaction variables correlate with surrogate variables of clinical outcome in children with pulmonary hypertension. Pulm. Circ. 9, 2045894019854074 (2019).
Ivy, D. D. et al. Short- and long-term effects of inhaled iloprost therapy in children with pulmonary arterial hypertension. J. Am. Coll. Cardiol. 51, 161–169 (2008).
pubmed: 18191742 pmcid: 3125969
Piastra, M. et al. Nebulized iloprost and noninvasive respiratory support for impending hypoxaemic respiratory failure in formerly preterm infants: a case series. Pediatr. Pulmonol. 47, 757–762 (2012).
pubmed: 22170702
Thomas, V. C. et al. Transcatheter closure of secundum atrial septal defect in infants less than 12 months of age improves symptoms of chronic lung disease. Congenit. Heart Dis. 7, 204–211 (2012).
pubmed: 21443579
Baruteau, A. E. et al. Palliative Potts shunt for the treatment of children with drug-refractory pulmonary arterial hypertension: updated data from the first 24 patients. Eur. J. Cardiothorac. Surg. 47, e105–e110 (2015).
pubmed: 25475943
Nagiub, M., Kanaan, U., Simon, D. & Guglani, L. Risk factors for development of pulmonary hypertension in infants with bronchopulmonary dysplasia: systematic review and meta-analysis. Paediatr. Respir. Rev. 23, 27–32 (2017).
pubmed: 28188008
Sheth, S., Goto, L., Bhandari, V., Abraham, B. & Mowes, A. Factors associated with development of early and late pulmonary hypertension in preterm infants with bronchopulmonary dysplasia. J. Perinatol. 40, 138–148 (2020).
pubmed: 31723236
Sweet, D. G. et al. European Consensus Guidelines on the Management of Respiratory Distress Syndrome—2019 Update. Neonatology 115, 432–450 (2019).
pubmed: 30974433 pmcid: 6604659
Vento, M., Bohlin, K., Herting, E., Roehr, C. C. & Dargaville, P. A. Surfactant administration via thin catheter: a practical guide. Neonatology 116, 211–226 (2019).
pubmed: 31461712
Belkhatir, K. et al. Variations in preterm stabilisation practices and caffeine therapy between two European tertiary level neonatal units. Acta Paediatr. 109, 488–493 (2020).
pubmed: 31512769
Zivanovic, S. & Roehr, C. C. One step further toward defining the optimal respiratory care package for neonates: interventions to successfully extubate preterm infants. JAMA Pediatr. 171, 120–121 (2017).
pubmed: 27918773
Hansmann, G. et al. Mesenchymal stem cell-mediated reversal of bronchopulmonary dysplasia and associated pulmonary hypertension. Pulm. Circ. 2, 170–181 (2012).
pubmed: 22837858 pmcid: 3401871
Chang, Y. S. et al. Mesenchymal stem cells for bronchopulmonary dysplasia: phase 1 dose-escalation clinical trial. J. Pediatr. 164, 966–972 e966 (2014).
pubmed: 24508444
Willis, G. R. et al. Mesenchymal stromal cell exosomes ameliorate experimental bronchopulmonary dysplasia and restore lung function through macrophage immunomodulation. Am. J. Respir. Crit. Care Med. 197, 104–116 (2018).
pubmed: 28853608 pmcid: 5765387
Rüdiger, M., Kirpalani, H., Steinhorn, R., Davis, J. M. & Thebaud, B. How to introduce MSC-based therapy for the developing lung safely into clinical care? Pediatr. Res. https://doi.org/10.1038/s41390-020-0758-0 (2020).
Nagiub, M., Lee, S. & Guglani, L. Echocardiographic assessment of pulmonary hypertension in infants with bronchopulmonary dysplasia: systematic review of literature and a proposed algorithm for assessment. Echocardiography 32, 819–833 (2015).
pubmed: 25231322
Levy, P. T., Patel, M. D., Choudhry, S., Hamvas, A. & Singh, G. K. Evidence of echocardiographic markers of pulmonary vascular disease in asymptomatic infants born preterm at one year of age. J. Pediatr. 197, 48–56.e2 (2018).
pubmed: 29625733 pmcid: 5970955
Patel, M. D. et al. Echocardiographic assessment of right ventricular afterload in preterm infants: maturational patterns of pulmonary artery acceleration time over the first year of age and implications for pulmonary hypertension. J. Am. Soc. Echocardiogr. 32, 884–894.e4 (2019).
pubmed: 31272593 pmcid: 6613806
Koestenberger, M. et al. Normal reference values and z scores of the pulmonary artery acceleration time in children and its importance for the assessment of pulmonary hypertension. Circ. Cardiovasc. Imaging 10, e005336 (2017).
pubmed: 28003222
Koestenberger, M. et al. Right ventricular outflow tract velocity time integral (RVOT VTI) and tricuspid regurgitation velocity/RVOT VTI ratio in pediatric pulmonary hypertension. Int. J. Cardiol. 212, 274–276 (2016).
pubmed: 27057933
Jone, P. N., Hinzman, J., Wagner, B. D., Ivy, D. D. & Younoszai, A. Right ventricular to left ventricular diameter ratio at end-systole in evaluating outcomes in children with pulmonary hypertension. J. Am. Soc. Echocardiogr. 27, 172–178 (2014).
pubmed: 24325962
Koestenberger, M. et al. Right ventricular end-systolic remodeling index in the assessment of pediatric pulmonary arterial hypertension. The European Pediatric Pulmonary Vascular Disease Network (EPPVDN). Pediatr. Res. https://doi.org/10.1038/s41390-020-0748-2 (2020).
McCrary, A. W. et al. Differences in eccentricity index and systolic-diastolic ratio in extremely low-birth-weight infants with bronchopulmonary dysplasia at risk of pulmonary hypertension. Am. J. Perinatol. 33, 57–62 (2016).
pubmed: 26171597

Auteurs

Georg Hansmann (G)

Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany. georg.hansmann@gmail.com.

Hannes Sallmon (H)

Department of Pediatric Cardiology, Charité University Medical Center, Berlin, Germany.

Charles C Roehr (CC)

Newborn Services, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
National Perinatal Epidemiology Unit, Nuffield Department of Population Health, Medical Sciences Division, University of Oxford, Oxford, UK.

Stella Kourembanas (S)

Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.

Eric D Austin (ED)

Division of Pediatric Pulmonary Medicine, Vanderbilt University, Nashville, TN, USA.

Martin Koestenberger (M)

Division of Pediatric Cardiology, Medical University of Graz, Graz, Austria.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female

Evaluation of Low-Value Services Across Major Medicare Advantage Insurers and Traditional Medicare.

Ciara Duggan, Adam L Beckman, Ishani Ganguli et al.
1.00
Humans United States Aged Cross-Sectional Studies Medicare Part C

Effectiveness of Virtual Yoga for Chronic Low Back Pain: A Randomized Clinical Trial.

Hallie Tankha, Devyn Gaskins, Amanda Shallcross et al.
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH

questionsmedicales.fr › Facteurs biologiques › Marqueurs biologiques › Pulmonary hypertension in bronchopulmonary dysplasia.
questionsmedicales.fr › Malformations et maladies congénitales, héréditaires et néonatales › Maladies néonatales › Maladies du prématuré › Dysplasie bronchopulmonaire › Pulmonary hypertension in bronchopulmonary dysplasia.
questionsmedicales.fr › Techniques d'investigation › Cathétérisme › Cathétérisme cardiaque › Pulmonary hypertension in bronchopulmonary dysplasia.
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie thoracique › Procédures de chirurgie cardiaque › Pulmonary hypertension in bronchopulmonary dysplasia.
questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Techniques de diagnostic cardiovasculaire › Tests de la fonction cardiaque › Échocardiographie › Pulmonary hypertension in bronchopulmonary dysplasia.
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Mécanismes moléculaires de l'action pharmacologique › Antagonistes des récepteurs de l'endothéline › Pulmonary hypertension in bronchopulmonary dysplasia.
questionsmedicales.fr › Maladies cardiovasculaires › Cardiopathies › Défaillance cardiaque › Pulmonary hypertension in bronchopulmonary dysplasia.
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Pulmonary hypertension in bronchopulmonary dysplasia.
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Hypertension artérielle › Hypertension pulmonaire › Pulmonary hypertension in bronchopulmonary dysplasia.
questionsmedicales.fr › Personnes › Tranches d'âge › Nourrisson › Nouveau-né › Pulmonary hypertension in bronchopulmonary dysplasia.
questionsmedicales.fr › Personnes › Tranches d'âge › Nourrisson › Nouveau-né › Prématuré › Pulmonary hypertension in bronchopulmonary dysplasia.
questionsmedicales.fr › Malformations et maladies congénitales, héréditaires et néonatales › Maladies néonatales › Maladies du prématuré › Pulmonary hypertension in bronchopulmonary dysplasia.
questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Imagerie diagnostique › Tomographie › Imagerie par résonance magnétique › Pulmonary hypertension in bronchopulmonary dysplasia.
questionsmedicales.fr › Produits chimiques inorganiques › Composés de l'oxygène › Oxydes › Oxydes d'azote › Monoxyde d'azote › Pulmonary hypertension in bronchopulmonary dysplasia.
questionsmedicales.fr › Thérapeutique › Thérapie respiratoire › Oxygénothérapie › Pulmonary hypertension in bronchopulmonary dysplasia.
questionsmedicales.fr › Facteurs biologiques › Médiateurs de l'inflammation › Autacoïdes › Éicosanoïdes › Prostaglandines › Prostaglandines I › Pulmonary hypertension in bronchopulmonary dysplasia.
questionsmedicales.fr › Composés hétérocycliques › Composés hétérocycliques à cycles fusionnés › Composés hétérobicycliques › Purines › Citrate de sildénafil › Pulmonary hypertension in bronchopulmonary dysplasia.
questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Imagerie diagnostique › Tomographie › Tomographie à rayons X › Tomodensitométrie › Pulmonary hypertension in bronchopulmonary dysplasia.
questionsmedicales.fr › Maladies cardiovasculaires › Cardiopathies › Valvulopathies › Insuffisance tricuspide › Pulmonary hypertension in bronchopulmonary dysplasia.
questionsmedicales.fr › Phénomènes physiologiques respiratoires et circulatoires › Phénomènes physiologiques cardiovasculaires › Hémodynamique › Résistance vasculaire › Pulmonary hypertension in bronchopulmonary dysplasia.
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Agents cardiovasculaires › Vasodilatateurs › Pulmonary hypertension in bronchopulmonary dysplasia.