Early Echocardiographic Predictors of Alveolar Capillary Dysplasia: A Case-Control Study

Abstract

Purpose To evaluate early echocardiographic measures of pulmonary hypertension and refractory hypoxemia in patients with ACD and matched controls. Methods and Materials A retrospective case-control study at a quaternary hospital was conducted from 2000 to 2011. ACD patients were compared to patients with meconium aspiration syndrome ± sepsis matched by gestational age and birthweight. All patients were on inhaled nitric oxide and ECMO. Demographics, onset of illness, presence of congenital anomalies, respiratory, and echocardiographic variables were studied. Two independent cardiologists, blinded to the identity of the cases and controls, prospectively reviewed the first admission echocardiograms. Results Five patients were identified with ACD by histopathology and matched to 5 controls. Demographics, onset of illness, presence of congenital anomalies, and respiratory variables were not statistically significant between the groups. Excellent inter-rater reliability readings of the echocardiograms between the two cardiologists were achieved (Kappa 0.75-1). There was no statistical difference in the tricuspid regurgitation (TR) velocities between the two groups; all ACD cases and 75% of the controls had TR velocities ≥ 3.2 m/sec. More ACD cases had moderate to severe tricuspid jet regurgitation (80% vs. none, p Conclusions The combination of moderate to severe RAE and tricuspid jet regurgitation unresponsive to maximal interventions should alert clinicians of the possibility for ACD. We speculate that early echocardiographic measures may identify at risk neonates for fatal ACD in the first postnatal week and lead to early enlistment for lung transplant.