Noninvasive Bedside Vasodilator Testing Using Echocardiography

摘要

class="kwd-title">Keywords: Vasodilator testing, Pulmonary hypertension, Congenital heart disease class="head no_bottom_margin" id="sec1title">IntroductionInhaled nitric oxide is a potent vasodilator used routinely for vasodilator testing and treatment in pediatric patients with pulmonary hypertension (PH). Vasodilator testing is an important initial step in the diagnosis and management of PH, and responsiveness to vasodilator testing can predict survival. Traditionally, vasodilator testing is performed during cardiac catheterization, which is invasive and higher risk in pediatric patients with PH because of the need for sedation or anesthesia. Noninvasive bedside vasodilator testing may be an option to help guide therapy in selected patients. Echocardiographic markers of PH severity, such as the systolic-to-diastolic duration ratio of the tricuspid regurgitation jet or the right ventricular (RV) Tei index have been shown to be associated with hemodynamic measures obtained by cardiac catheterization and may predict long-term outcomes, including survival., We report the use of echocardiography to measure immediate responsiveness to acute vasodilator testing as a noninvasive bedside approach in an infant with postoperative PH. The immediate echocardiographic changes seen with the initiation of vasodilator therapy are novel and previously unreported in the pediatric literature. The use of echocardiography in this patient was instrumental in his diagnosis and management and facilitated his eventual transition to oral targeted therapy without the need for more invasive testing.