What question did this study set out to answer?

To assess the necessity of lifelong pulmonary vascular monitoring in individuals with a history of bronchopulmonary dysplasia.

May 20, 2026

B60-05 A Case That Outgrew the Guidelines: Lifelong Pulmonary Vascular Surveillance in a Former Preterm Child With Bronchopulmonary Dysplasia

Key Points

To assess the necessity of lifelong pulmonary vascular monitoring in individuals with a history of bronchopulmonary dysplasia.
Case presentation of a 20-year-old male with chronic lung disease of prematurity and pulmonary hypertension history.
Monitoring included serial transthoracic echocardiograms and cardiac catheterizations to evaluate pulmonary vascular disease.
Discussion of implications for screening protocols in adults with histories of preterm birth and bronchopulmonary dysplasia.
Patient had a resolution of pulmonary hypertension by the age of 5, with intermittent elevations noted through serial monitoring.
Recent cardiac catheterization at 17 years revealed mild pulmonary hypertension (mPAP 24 mmHg, PVRi 4 Wood units·m²) without clinical symptoms.
Routine transthoracic echocardiograms may not consistently align with results from cardiac catheterization, indicating a need for reevaluation strategies.

Abstract

Abstract Introduction Survivors of preterm birth are an increasing population, with over 15 million individuals reaching adulthood globally. Many have chronic lung disease (CLD) of prematurity, placing them at risk for cardiopulmonary complications, including pulmonary hypertension (PH). Case Presentation A 20-year-old male, born at 25 weeks’ gestation weighing 1040 g, with CLD of prematurity and a history of PH, mild intermittent asthma, and attention deficit/hyperactivity disorder presents for routine pulmonary vascular disease (PVD) monitoring. He is off PH-specific therapies and is asymptomatic and tolerating daily activity. His current medications include methylphenidate and infrequent use of albuterol. Methylphenidate started at approximately 7.5-years-old, with use debated due to the unknown risk in patients with PH (so breaks off the medication were performed, Figure 1). A transthoracic echocardiogram (TTE) completed during his clinic visit was normal without indirect evidence of PH. Of note, he had PH resolution by TTE at age 5 years, oxygen therapy discontinued at age 7 years, and his clinical course was otherwise notable for lifelong disease monitoring with serial TTEs showing intermittent elevation in right ventricular pressure (RVP) prompting cardiac catheterization (CC). His CC at 8-years-old was reassuring despite screening TTE showing high RVP. Most recent CC at 17-years-old found mild PH (mPAP 24 mmHg, PVRi 4 Wood units·m²), but he remained clinically well without treatment. Although recent TTE was reported reassuring, repeat CC is anticipated given the variability in TTE findings over his lifetime. Discussion This case illustrates how the burden of cardiopulmonary disease associated with prematurity extends beyond early childhood. Thus, screening for PVD in young adults with a history of BPD, regardless of symptoms, may be warranted. Additionally, this case highlights how routine TTE may not always precisely correlate with findings on cardiac catheterization, the gold standard for confirming PH. While TTE is widely used, its limitations in children with CLD are well recognized. Interestingly, our patient remained on a stimulant medication throughout his childhood, and it is unclear if the initiation or prolonged use of the medication contributed to his abnormal TTEs or his presentation of mild PH on cardiac catheterization. Despite the known increased risk of PH in this population, the prevalence of long-term disease burden is unknown and evidence-based guidelines for long-term PVD screening are lacking. Understanding factors that may increase the risk of PVD to former preterm children and improving our approach to screening and management is necessary to mitigate long-term complications. This abstract is funded by: None

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