title: Initial experience with bosentan (Tracleer) as treatment for pulmonary arterial hypertension (PAH) due to congenital heart disease in infants and young children.
abstract: BACKGROUND
  Bosentan, a dual endothelin-receptor antagonist, has been shown to be an effective treatment option in patients with the idiopathic form of pulmonary arterial hypertension (PAH). We used bosentan as compassionate treatment in infants and young children with congenital heart disease (CHD) who had a) PAH preoperatively representing a contraindication to corrective surgery or b) persisting PAH after corrective surgery causing right heart failure and reduced exercise tolerance.
  
  
  METHODS
  Seven children with PAH due to CHD (median age 3.8 years; range 1.5 to 6.4 years) received 3 mg/kg/d bosentan (Tracleer) orally. Clinical, echocardiographic and hemodynamic parameters were measured and laboratory tests performed before treatment and during steady state while on treatment. Routine liver function parameters were monitored monthly.
  
  
  RESULTS
  Mean bosentan treatment time was 8.6+/-5 months. During bosentan therapy there were no significant adverse events. The clinical status remained stable or improved in all patients: NYHA class decreased from 2.6+/-0.6 to 1.7+/-0.6 (p<0.05). This was associated with a mean reduction of the right ventricular systolic pressure (RVSP) from 96+/-11 mmHg to 71+/-26 mmHg (p<0.05).
  
  
  CONCLUSIONS
  Treatment with bosentan in infants and young children with PAH due to congenital heart disease was tolerated without significant side effects and resulted in stabilization of clinical status. A significant reduction in right ventricular systolic pressure (RVSP) could be demonstrated. These results suggest that the dose regimen used is appropriate and safe for the treatment of infants and children with PAH, resulting in a reduction of pathologically increased pulmonary vascular resistance.
authors.affiliation: Klinik für Angeborene Herzfehler/Kinderkardiologie, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Gilbert
authors.forename: Y-C
authors.initials: YC
authors.lastname: Luther
authors.forename: O
authors.initials: O
authors.lastname: Miera
authors.forename: N
authors.initials: N
authors.lastname: Nagdyman
authors.forename: P
authors.initials: P
authors.lastname: Ewert
authors.forename: F
authors.initials: F
authors.lastname: Berger
authors.forename: P E
authors.initials: PE
authors.lastname: Lange
authors.forename: I
authors.initials: I
authors.lastname: Schulze-Neick
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D000077300:Bosentan; D002648:Child; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000209:etiology*; D007223:Infant; D008297:Male; D010166:Palliative Care / Q000379:methods*; D010865:Pilot Projects; D011651:Pulmonary Artery / Q000187:drug effects; D013449:Sulfonamides / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D013449:Sulfonamides; D000077300:Bosentan