3D Echocardiographic Evaluation of the Right Ventricle before and after Inhaled Nitric Oxide Therapy for Persistent Pulmonary Hypertension of the Newborn
2Department of Neonatal Intensive Care Unit, Gifu Prefectural General Medical Center, Japan
3Department of Pediatrics, Graduate School of Medicine, Gifu University, Japan
Introduction: In contrast to the near conical shape of the left ventricle (LV), the right ventricle (RV) is more triangular in shape when viewed from the front and it curves over the LV. Therefore, it is difficult to evaluate the RV with 2D Echocardiograpy.
Purpose: The purpose of this study is to examine the RV before and after inhaled nitric oxide therapy (iNO) for persistent pulmonary hypertension of the newborn (PPHN) with Real-time three-dimensional echocardiography (RT3DE) qualitatively and quantitatively.
Methods: Five infants with PPHN were prospectively enrolled, 2 with severe birth asphyxia, 2 with extremely low birth weight and 1 with trisomy 21. RT3DE images were also gathered over using a matrix array transducer for several seconds. The volume analysis was performed on semi-automatic software TomTec RV Function 2.0TM and TomTec LV Analysis 3.1TM.
Results: In all infants, the RV ejection fraction improved after iNO (median (interquartile range) 28.2 % before iNO (21.3 % – 38.4 %)→ 40.5 % after iNO (35.0 % – 44.6 %)). Furthermore, the ventricular systolic time difference (RV systolic time – LV systolic time) were shortened after iNO（median(interquartile range) 84.7 ms before iNO (57.1 ms – 100.9 ms)→25.4 ms after iNO (12.7 ms – 72.5 ms)).
Conclusions: RT3DE is easier, faster and more precise method of evaluating RV function in infants than 2D. Furthermore, it needs to be emphasized that it is possible to evaluate the ventricular interdependence only with RT3DE.
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