| Peri-operative pulmonary hypertension in paediatric patients: current strategies in children with congenital heart disease. | |
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MedLine Citation:
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PMID: 20424447 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Matthias Gorenflo; Hong Gu; Zhuoming Xu |
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Publication Detail:
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Type: Consensus Development Conference; Journal Article; Research Support, Non-U.S. Gov't Date: 2010-04-24 |
Journal Detail:
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Title: Cardiology Volume: 116 ISSN: 1421-9751 ISO Abbreviation: Cardiology Publication Date: 2010 |
Date Detail:
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Created Date: 2010-06-04 Completed Date: 2010-09-16 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 1266406 Medline TA: Cardiology Country: Switzerland |
Other Details:
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Languages: eng Pagination: 10-7 Citation Subset: IM |
Copyright Information:
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Copyright (c) 2010 S. Karger AG, Basel. |
Affiliation:
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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:
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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:
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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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