Document Detail


Peri-operative pulmonary hypertension in paediatric patients: current strategies in children with congenital heart disease.
MedLine Citation:
PMID:  20424447     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Congenital heart disease (CHD) is responsible for pulmonary hypertension (PH) in children in about 50% of cases. This pre-operative dynamic pulmonary hypertension can be superimposed and aggravated by acute post-operative PH or persist as chronic PH, especially in children who are not operated on early enough. Inhaled iloprost, a stable prostacyclin analogue, is used for the post-operative management of PH in infants and children with CHD. In a prospective open-label proof-of-concept study, the efficacies of inhaled nitric oxide (iNO) and inhaled iloprost were directly compared. Primary endpoints were the occurrence of a major or minor pulmonary hypertensive crisis. No significant difference between the effects of iNO versus iloprost on peri-operative PH was observed. Neither substance on its own prevented pulmonary hypertensive crises in high-risk infants, so a combination of both substances should be tested in future trials. In China, there are more than 4 million untreated CHD patients. More than 50% of them are untreated adults. Acute pulmonary vasoreactivity tests were performed in CHD patients between 9 months and 43 years of age using inhaled iloprost, in order to find out whether a pre-operative response to inhaled iloprost is a good predictor for the post-operative performance of these patients. The results showed that patient selection criteria for surgery should include both a 20% reduction in pulmonary vascular resistance (PVR) index after iloprost inhalation and a resulting PVR index <11 Wood U/m(2). CHD children between 14 days and 11 years of age took part in a placebo-controlled pilot study that investigated the role of aerosolized iloprost in the treatment of PH after corrective surgery. They received either low- or high-dose iloprost or placebo. Inhaled iloprost significantly improved haemodynamics in a dose-dependent manner and prevented reactive PH and pulmonary hypertensive crises in most of these mechanically ventilated children after CHD repair.
Authors:
Matthias Gorenflo; Hong Gu; Zhuoming Xu
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Publication Detail:
Type:  Consensus Development Conference; Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-04-24
Journal Detail:
Title:  Cardiology     Volume:  116     ISSN:  1421-9751     ISO Abbreviation:  Cardiology     Publication Date:  2010  
Date Detail:
Created Date:  2010-06-04     Completed Date:  2010-09-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1266406     Medline TA:  Cardiology     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  10-7     Citation Subset:  IM    
Copyright Information:
Copyright (c) 2010 S. Karger AG, Basel.
Affiliation:
Department of Paediatric Cardiology, University Hospital Leuven, UZ Leuven Campus Gasthuisberg, Herestraat 49, Leuven, Belgium. matthias.gorenflo@uz.kuleuven.ac.be
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MeSH Terms
Descriptor/Qualifier:
Cardiac Surgical Procedures*
Child
Heart Defects, Congenital / mortality,  surgery*
Humans
Hypertension, Pulmonary / drug therapy*,  mortality
Iloprost / therapeutic use*
Nitric Oxide / therapeutic use
Perioperative Care / methods*
Postoperative Complications / drug therapy*,  mortality
Risk Factors
Vasodilator Agents / therapeutic use
Chemical
Reg. No./Substance:
0/Vasodilator Agents; 10102-43-9/Nitric Oxide; 78919-13-8/Iloprost

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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