[Treatment of pulmonary arterial hypertension in children].
Treatment strategies for pulmonary hypertension in children have dramatically evolved. Traditional therapy with calcium channel blockers and pulmonary transplantation is only indicated in selected patients and does not reduce mortality very significantly. New pulmonary vasodilators are emerging from recent trials in the adult population. Their indications are based on the patient's NYHA classification. The epoprostenol (prostacyclin, Flolan) has shown reduction in mortality and improvement in functional symptoms in pediatric patients. The frequent side effects and continuous intravenous infusion limit the indication of prostacyclin in NYHA class IV children. The endothelin receptor blocker bosentan (Tracleer) is an orally given agent. It improves functional symptoms in adults and hemodynamic measures in children. It can be started in children with moderate functional symptoms (NYHA class II and III). The type V phosphodiesterase inhibitor sildenafil (Viagra) is being evaluated and may represent a promising therapy in the future. Invasive strategies like catheter-based atrial septostomy may be useful in particular cases. Randomized-controlled studies are urgently needed to evaluate the safety and efficacy of these new therapies.
Service de cardiologie pédiatrique, département de cardiologie, hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France. afraisse@mail.ap-hm.fr
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D000959:Antihypertensive Agents / Q000627:therapeutic use; D000077300:Bosentan; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D017115:Catheter Ablation; D002648:Child; D011464:Epoprostenol / Q000627:therapeutic use; D006325:Heart Atria / Q000601:surgery; D006801:Humans; D006976:Hypertension, Pulmonary / Q000145:classification / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016040:Lung Transplantation / Q000639:trends; D018579:Patient Selection; D010372:Pediatrics / Q000379:methods* / Q000639:trends; D010879:Piperazines / Q000627:therapeutic use; D011687:Purines; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D000068677:Sildenafil Citrate; D013449:Sulfonamides / Q000627:therapeutic use; D013450:Sulfones; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use
D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D010879:Piperazines; D011687:Purines; D013449:Sulfonamides; D013450:Sulfones; D014665:Vasodilator Agents; D000068677:Sildenafil Citrate; D011464:Epoprostenol; D000077300:Bosentan