ABSTRACT
Central to the assessment of acute or chronic pulmonary hypertension (PH) in neonates, is a comprehensive evaluation of severity of PH, evaluation of right and left ventricular performance, and appraisal of intra- and extracardiac shunts. This can be achieved by characterizing the physiology with echocardiography, which may also be utilized to facilitate diagnosis, inform treatment decisions, and determine response to therapy. Assessment of the severity of PH includes evaluation of the interventricular septal wall motion, tricuspid regurgitant jet velocity, and pulmonary vascular resistance. Performance of both the right and left ventricles can be assessed using ejection fraction, strain analysis, and tissue Doppler imaging and the impact to ventricular output. Tricuspid annular plane systolic excursion is another variable used to evaluate the longitudinal motion of the right ventricle. Also important to the assessment of PH is appraisal of intra- and extracardiac shunts including patent ductus arteriosus, patent foramen ovale, and ventricular septal defects. Appraisal of cardiac anatomy to exclude congenital heart disease is an integral component of the assessment of the hypoxic neonate. A holistic approach is imperative to appropriately assess interval hemodynamic changes, changes in or contributions from shunts, and a complete evaluation of RV performance.
