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Presentation and echocardiographic markers of neonatal hypertensive cardiomyopathy. Pediatrics 2006 Sep;118(3):e782-5

Date

08/02/2006

Pubmed ID

16880252

DOI

10.1542/peds.2006-0631

Scopus ID

2-s2.0-33749067656   19 Citations

Abstract

BACKGROUND: Systemic hypertension is a rare but important cause of neonatal heart failure. It is critical that this etiology be recognized and distinguished from other causes of myocardial dysfunction in young infants, because diagnostic studies, treatments, and prognoses are quite different.

METHODS: Between 1991 and 2005, 11 neonates were diagnosed as having neonatal cardiomyopathy and systemic hypertension through retrospective review of the Children's Hospital of Wisconsin database.

RESULTS: All infants in the cohort were found to have systemic hypertension (blood pressure of > 95th percentile for gestational age and weight). Causes included renovascular disease (n = 9), aortic obstruction secondary to thrombus (n = 1), and steroid use (n = 1). Echocardiography was performed at presentation for all patients because of cardiomegaly and/or hypertension. Echocardiographic findings were consistently striking for (1) left ventricular systolic dysfunction without chamber dilation, (2) concentric left ventricular hypertrophy, (3) left atrial dilation, and (4) aortomegaly. No anatomic aortic arch obstruction was identified, but Doppler findings for the descending thoracic aorta were uniformly consistent with elevated systemic vascular resistance. One patient died as a result of overwhelming thrombotic disease; all other patients responded to afterload reduction therapy with normalization of left ventricular systolic function during infancy.

CONCLUSIONS: Hypertensive cardiomyopathy can present in neonates with nonspecific symptoms and systemic hypertension. Because sometimes hypertension in infants is ignored or misinterpreted as agitation, echocardiography can provide critical markers of the disease.

Author List

Peterson AL, Frommelt PC, Mussatto K

Authors

Peter C. Frommelt MD Professor in the Pediatrics department at Medical College of Wisconsin
Kathleen Mussatto in the CTSI department at Medical College of Wisconsin - CTSI




MESH terms used to index this publication - Major topics in bold

Aorta
Cardiomyopathies
Echocardiography
Female
Humans
Hypertension
Infant, Newborn
Male
Retrospective Studies
Ventricular Dysfunction, Left
jenkins-FCD Prod-399 190a069c593fb5498b7fcd942f44b7bc9cdc7ea1