Epoprostenol treatment in children with severe pulmonary hypertension.
BACKGROUND
Severe, sustained pulmonary arterial hypertension leads to a progressive reduction in exercise capacity, right heart failure and death. Use of intravenous epoprostenol has improved survival in adults, but data are limited in children.


METHODS
This study included all 39 children treated with continuous intravenous epoprostenol since November 1997 at Great Ormond Street Hospital for Children (London, UK). Patients were aged 4 months to 17 years (median 5.4 years) at the onset of therapy. The male:female ratio was 1:1.3. 25 patients had idiopathic pulmonary arterial hypertension and 14 had pulmonary arterial hypertension associated with congenital heart disease, connective tissue disease, chronic lung disease or HIV. All were in WHO functional class III and IV. Mean pulmonary arterial pressure (SD) was 59 (17) mmHg and mean pulmonary vascular resistance was 23.3 (11.6) units x m(2). Patients were assessed regularly (2-3 monthly intervals) by physical examination, electrocardiography, transthoracic echocardiography and a 6-min walk test, when practicable.


RESULTS
The mean duration of follow-up was 27 (21) months. 7 patients died and 8 underwent transplantation. Cumulative survival at 1, 2 and 3 years was 94, 90 and 84%. The 6-min walking distance improved by a mean of 77 m (p<0.003). WHO functional class improved during the first year (p<0.001) and improvement was maintained for up to 3 years. Weight improved significantly from a baseline z score of -1.55 (1.74) to -1.16 (1.8) (p<0.03). 28 children had additional oral specific therapy. Hickman line changes were 0.33/patient year.


CONCLUSIONS
Epoprostenol therapy improved survival, WHO functional class, exercise tolerance and ability to thrive in children with severe pulmonary arterial hypertension. Epoprostenol represents an effective and feasible therapy even in young children.
Lammers
Astrid E
AE
Great Ormond Street Hospital for Children and Institute of Child Health, London, UK.
Hislop
Alison A
AA
Flynn
Yvette
Y
Haworth
Sheila G
SG
D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D011464:Epoprostenol / Q000627:therapeutic use*; D017079:Exercise Tolerance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D007223:Infant; D007262:Infusions, Intravenous; D053208:Kaplan-Meier Estimate; D008297:Male
D000959:Antihypertensive Agents; D011464:Epoprostenol