Document Detail


Doppler Parameters of Fetal Lung Hypoplasia and Impact of Sildenafil.
MedLine Citation:
PMID:  24631434     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
RATIONALE: Congenital diaphragmatic hernia (CDH) is clinically challenging due to associated lung hypoplasia (LH). There have been no validated parameters to evaluate fetal LH severity. Sildenafil has been shown to improve LH mass in Nitrofen-induced CDH models, but the pulmonary vascular tone has not been evaluated in vivo.
OBJECTIVES: To identify the pulmonary artery (PA) Doppler parameter that best predicts LH severity and to investigate the efficacy of antenatal sildenafil treatment in experimental CDH.
METHODS: Nitrofen (50-60% CDH in offspring) or vehicle on E9.5 and sildenafil or vehicle on E11.5-20.5 were administrated to pregnant rats. On E20.5, PA Doppler indices were investigated with and without maternal hyperoxia. The presence/absence of CDH, lung/body weight ratio (LW/BW) and radial saccular count were assessed at E20.5.
RESULTS: At baseline, CDH rats had lower PA Doppler acceleration/ejection time ratios and pulsatility index (PI). Maternal hyperoxia resulted in a significant decrease in the PA PI suggesting pulmonary vasodilation. In contrast, in CDH fetuses, the ipsilateral PA PI showed little or no response to hyperoxia (p>0.05), and in those with LH, PI response with maternal hyperoxia correlated positively with LW/BW (r=0.70, p=0.01). Maternal sildenafil therapy significantly improved PA response to hyperoxia and lung growth in CDH fetuses (p<0.01).
CONCLUSIONS: Pulmonary vasodilation that occurs in E20.5 fetal rats in response to maternal hyperoxia is blunted in CDH. Change in PA PI with hyperoxia is a useful predictor of LH severity. Sildenafil improves pulmonary vascular response and lung growth in fetal CDH.
Authors:
Yuka Yamamoto; Bernard Thebaud; Arul Vadivel; Farah Eaton; Venu Jain; Lisa K Hornberger
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-3-11
Journal Detail:
Title:  American journal of obstetrics and gynecology     Volume:  -     ISSN:  1097-6868     ISO Abbreviation:  Am. J. Obstet. Gynecol.     Publication Date:  2014 Mar 
Date Detail:
Created Date:  2014-3-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370476     Medline TA:  Am J Obstet Gynecol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2014 Mosby, Inc. All rights reserved.
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