• Neonatal Medicine
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• v.28 no.1
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• pp.1-6
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• 2021

Persistent pulmonary hypertension of the newborn (PPHN) is a consequence of the failure of a decrease in the elevated pulmonary vascular resistance after birth. Pulmonary vasodilators, including inhaled nitric oxide (iNO), have been the mainstream of targeted therapy for PPHN, but no drugs have been proven to be effective in preterm infants with PPHN. The fetus remains hemodynamically stable despite lower arterial oxygen tension and pulmonary blood flow as compared to full-term newborns. This adaptation is due to the lower oxygen requirement and high oxygen-carrying capacity of fetal circulation. The immature lungs of preterm infants are more vulnerable to reactive oxygen species, and the response of pulmonary vascular dilatation to blood oxygen tension is blunted in preterm infants. Recently, iNO has been reported to be effective in a selected group of preterm infants, such as those with prolonged preterm rupture of membrane-oligohydramnios-pulmonary hypoplasia sequence. PPHN in preterm infants, along with maximum supportive treatment based on fetal physiology and meticulous assessment of cardiovascular function, is in dire need of new treatment guidelines, including optimal dosing strategies for pulmonary vasodilators.

• Journal of Veterinary Clinics
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• v.37 no.6
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• pp.311-316
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• 2020

Biomarkers used in dogs with heartworm disease include N-terminal pro B-type natriuretic peptide (NT-proBNP) and cardiac troponin I (cTnI), which are associated with damage to the myocardium. Pulmonary hypertension is one of the clinical signs of canine heartworm disease. The purpose of this study is to investigate the change in the concentration of each biomarker, severity of pulmonary hypertension and the correlation between biomarkers according to the severity of clinical signs. Five healthy dogs and 10 heartworm-infected dogs were recruited for the study. The heartworm-infected group was classified based on the history, clinical signs, and blood assay, thoracic radiography, and echocardiography after confirming the infection according to the results of the commercial ELISA kit (SNAP test, IDEXX Laboratories, Maine, USA). NT-proBNP was higher in the severely infected group than the control group (p < 0.05); cTnI was also higher in the severely infected group than the control group (p < 0.05). The pressure gradient of pulmonary hypertension was higher in the severe group than the mild group (p < 0.05). The severity of pulmonary hypertension was correlated with NT-proBNP (r = 0.818, p < 0.01), cTnI (r = 0.894, p < 0.01). When the correlation of the two serum values for each group was examined, a correlation was not found in the mild group (r = 0.707, p = 0.182), but a correlation was found in the severe group (r = 0.9, p < 0.05). NT-proBNP and cTnI were significantly increased and correlated with severe clinical signs. Pulmonary hypertension was significant higher in the severe group than in the mild group (p < 0.05). Evaluation of blood biomarker concentration and severity of pulmonary hypertension and referring to each correlation between these indicators may be helpful to assess the severity of the heartworm disease.

• The Journal of Korean Medicine
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• v.24 no.2
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• pp.213-218
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• 2003

Objectives : There has been little report on the treatment of pulmonary hypertension on the basis of Oriental medicine. Several weeks ago we had a case of pulmonary hypertension, and found something in the treatment of the disease. A 60-year old man with hemoptysis was admitted to the Kyunghee Oriental Medical Center on April 23, 2002 and discharged May 4, 2002. During that time, we saw good results. Methods : On the oriental medical basis that Chuongsangboha-tang (Qingshangbuxia-tang) has an effect on chronic pulmonary disease, we treated him with that medicine three times a day for 12 days along with Roxithromycin 150mg/tab 1T qd, Digoxin 0.25mg/tab 0.5T qd, and Bambuterol Hel 1T qd. He was also given acupuncture therapy daily with tonifying SP3(太白), L9(太淵) and sedating H8(少府), L10(魚際). Results : The following data was observed from the therapy : hemoptysis volume decreased by 90%, general weakness by 40%m and ABGA results improved. Conclusions : As we managed pulmonary hypertension, we came to the conclusion that the oriental medical therapy can be of assistance to western medical therapy and can mitigate hemoptysis.

• Journal of Chest Surgery
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• v.22 no.5
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• pp.775-780
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• 1989

This study concerns the late results observed at follow-up[average: 32.5 months] of 23 patients, in whom Patent Ductus Arteriosus with pulmonary hypertension among 55 patients. They were operated from May 1984 to July 1987 in Chonnam University Medical School. There was predominance of woman [2.5:1]. No operative death occurred. All of patients subside preoperative symptoms, but 1 patient diagnosed recannalization of duct at follow-up. Systolic murmur was found over the pulmonary area in 5 patients [22 %], but it may be not related to systolic pulmonary arterial pressure[SPAP]. Also, SPAP were normalized in 74 % of patients and had mild hypertension in 26 % of patients. Although the patients had Patent Ductus Arteriosus with pulmonary hypertension, successful surgical correction was carried out safely in all instance but one, by ligation and facilitated by hypotensive anesthesia.

• Journal of Chest Surgery
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• v.48 no.1
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• pp.52-54
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• 2015

Idiopathic pulmonary arterial hypertension eventually leads to right-sided heart failure and sudden death. Its mortality rate in children is still high, despite improvements in pharmacological therapy, and therefore novel treatments are necessary. The Potts shunt, which creates an anastomosis between the left pulmonary artery and the descending aorta, has been proposed as a theoretically promising palliative surgical technique to decompress the right ventricle. We report the case of a 12-year-old girl with suprasystemic idiopathic pulmonary hypertension and right ventricular failure who underwent a Potts shunt for palliation with good short-term results.

• Clinical and Experimental Pediatrics
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• v.48 no.2
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• pp.216-220
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• 2005

Pulmonary arteriovenous fistulas(PAVFs) is a rare disorder that occurs in two to three children per 100,000 population. It is presented as absence of intervening capillary beds between the pulmonary artery and vein with resultant persistent right to left shunt. Other causes include trauma, liver cirrhosis, malignancy and schistosomiasis. It is mostly asymptomatic, but it may present with respiratory difficulty, cyanosis, clubbed fingers induced by right to left shunt or hemoptysis, polycythemia and epistaxis. Major complications, such as brain abscess, brain embolism, paradoxical embolism and subacute infective endocarditis can be devastating, so therapeutic intervention is recommended in all patients. However, removal of low-resistance fistulas can aggrevate pulmonary hypertension, so detection of increased pulmonary pressure is important. We report two patients : One a 42 year-old male with PAVFs treated with coil embolization, and a 42 year-old female who was treated with anticoagulants due to pulmonary hypertension.

• Journal of Veterinary Clinics
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• v.37 no.4
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• pp.185-190
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• 2020

This retrospective, echocardiographic study using 144 dogs with clear systolic tricuspid regurgitation on Doppler echocardiography was performed to determine the diagnostic value of the systolic tricuspid regurgitation velocity/pulmonary artery flow velocity time integral to predict the Doppler estimates of dogs with tricuspid regurgitation pressure gradient compared with other cardiac indices of pulmonary hypertension, and to investigate a cutoff value to select patients with a potentially poor outcome. The systolic tricuspid regurgitation velocity/pulmonary artery flow velocity time integral increased significantly as the severity of pulmonary hypertension increased and had a correlation coefficient that was analogous to those of other conventional cardiac indices. A cutoff value greater 1.65 provided the best-balanced sensitivity (84%) and specificity (80%) in determining patients with a poor prognosis. In conclusion, the systolic tricuspid regurgitation velocity/pulmonary artery flow velocity time integral is readily obtained using routine echocardiography and could provide a non-invasive, novel, and supplementary index for evaluating dogs with pulmonary hypertension as useful prognostic criteria, particularly in those with advanced pulmonary hypertension.

• Journal of Chest Surgery
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• v.23 no.2
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• pp.245-252
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• 1990

To see the change of pulmonary arterial pressure after mitral valve replacement, postoperative cardiac catheterization and echocardiographies were performed in 12 patients of mitral valvular disease with pulmonary hypertension[systolic pulmonary arterial pressure>50 mm Hg]. The mean follow-up duration was 35.4[range: 15-47] months per patient. The following results were obtained. 1] Preoperative systolic pulmonary arterial pressure value of 66.17\ulcorner10.73mmHg decreased significantly to 29.17\ulcorner6.86mmHg postoperatively[p<0.01]. 2] Preoperative Pp/Ps value of 0.67\ulcorner0.13 decreased significantly to 0.28\ulcorner0.06 postoperatively[p<0.01]. 3] Preoperative PAWP value of 29.00\ulcorner4.02mmHg decreased significantly to 9.92\ulcorner4.27 mmHg postoperatively[p<0.01]. 4] Preoperative LAD value of 5.58\ulcorner1.20cm decreased significantly to 4.37\ulcorner0.67cm postoperatively [p<0.01]. In conclusion, pulmonary arterial hypertension secondary to mitral valvular disease could be reduced to normal range after successful mitral valve replacement.

• Molecules and Cells
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• v.37 no.3
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• pp.196-201
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• 2014

Pulmonary arterial hypertension (PAH) is a progressive disease characterized by the vascular remodeling of the pulmonary arterioles, including formation of plexiform and concentric lesions comprised of proliferative vascular cells. Clinically, PAH leads to increased pulmonary arterial pressure and subsequent right ventricular failure. Existing therapies have improved the outcome but mortality still remains exceedingly high. There is emerging evidence that the seven-transmembrane G-protein coupled receptor APJ and its cognate endogenous ligand apelin are important in the maintenance of pulmonary vascular homeostasis through the targeting of critical mediators, such as Kr$\ddot{u}$ppel-like factor 2 (KLF2), endothelial nitric oxide synthase (eNOS), and microRNAs (miRNAs). Disruption of this pathway plays a major part in the pathogenesis of PAH. Given its role in the maintenance of pulmonary vascular homeostasis, the apelin-APJ pathway is a potential target for PAH therapy. This review highlights the current state in the understanding of the apelin-APJ axis related to PAH and discusses the therapeutic potential of this signaling pathway as a novel paradigm of PAH therapy.

• Journal of Chest Surgery
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• v.52 no.4
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• pp.232-235
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• 2019

A 2.5-kg neonate with coarctation of the aorta and a small left ventricle experienced a severe pulmonary hypertensive crisis. An emergency pulmonary artery-to-systemic artery shunt was placed to break the positive feedback loop caused by pulmonary hypertension and functional mitral stenosis. This shunt provided immediate relief of suprasystemic pulmonary hypertension and the resultant low cardiac output.