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Good Morning and Welcome Applicants!

Good Morning and Welcome Applicants!. January 27, 2011. Pulmonary HTN. Pulmonary Artery Pressure = L atrial pressure + ( pulm flow x pulm vascular resis ) Any increase can lead to pulm HTN. Pulmonary HTN. Progressive Pulmonary artery pressure >25 mm Hg Untreated

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Good Morning and Welcome Applicants!

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  1. Good Morning and Welcome Applicants! January 27, 2011

  2. Pulmonary HTN • Pulmonary Artery Pressure = L atrial pressure + (pulm flow x pulm vascular resis) • Any increase can lead to pulm HTN

  3. Pulmonary HTN • Progressive • Pulmonary artery pressure • >25 mm Hg • Untreated • RV unable to support circulation • Prognosis determined by reversibility of underlying process

  4. PPHN • Most common cause of PHTN in the newborn • 0.2% of newborns • Usually associated with respiratory conditions • Elevated pulmvasc resistance • Right to left shunting • Foramen ovale • Ductusarteriosis • Significant hypoxemia • Idiopathic

  5. PPHN • Presentation • Profound and labile hypoxemia • Out of proportion to parenchymal disease • Birth or gradual changes • Cyanosis • Grunting • Flaring • Retractions • Tachypnea • Tachycardia • Shock

  6. PPHN • Wide variety of severity • Normal perfusion to shock • Hypoxemia and acidosis • Further constricts the pulmonary vessels increasing the PH and creating a cycle

  7. PPHN • Shunting • PDA • Pre and post ductal • PaO2 gradient of >20 mmHg • O2 saturation gradient of >5%

  8. PPHN • X-rays • Underlying illness • Clear • Diminished vascular markings • Slightly dilated heart • Idiopathic

  9. PPHN • Echo • Must exclude cyanotic heart disease • R to L shunting across foramen ovale or ductusarteriosis • Deviation of the atrial septum • Ventricular septum • Right atrial enlargement • Tricuspid regurgitation

  10. PPHN • Treatment • Underlying disturbances • Hypoglycemia • Hypocalcemia • Polycythemia • Hypothermia • Minimal Stimulation

  11. PPHN • Treatment • Increase systemic resistance • Volume • Inotropic • Decrease R to L shunt • Decrease pulmonary vascular resistance • Oxygen • iNO

  12. PPHN • Treatment • Mechanical ventilation • High-frequency ventilation • Sedation • Surfactant • ECMO

  13. PPHN • Outcomes • 95% Meconium aspiration • 50% Congenital diaphragmatic hernia • Neurodevelopmental impairment • Neurosensory hearing loss • Behavioral problems • Respiratory difficulties • Most likely due to the underlying condition and severity

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