Clinical practice: pulmonary hypertension in children.
BACKGROUND
Pulmonary arterial hypertension is a rare disorder in childhood, the two most common types being idiopathic pulmonary arterial hypertension and pulmonary hypertension associated with congenital left-to-right shunt lesions, together accounting for almost 90% of cases.


CONCLUSIONS
The clinical presentation of idiopathic pulmonary arterial hypertension (familial and non familial) is essentially non-specific and varies with age. Pulmonary vasoreactivity testing identifies responders and non-responders. Responders are treated with calcium channel blockers and have a better prognosis. Non-responders have a very limited survival beyond diagnosis if not treated with more selective pulmonary arterial vasodilators. Prostacyclin, endothelin receptor antagonists and phosphodiesterase-5 inhibitors improve haemodynamics, functional class and exercise tolerance and delay deterioration. Patients with congenital left-to-right shunts and irreversible pulmonary arterial hypertension leading to Eisenmenger's syndrome have multiple organ disease. Despite a very pronounced exercise intolerance, their clinical course is rather stable with survival up to 40-60 years, depending on the complexity of their underlying cardiac defect. Treatment is based on general measures along with the same three types of selective pulmonary vasodilators as in idiopathic pulmonary arterial disease. Improvement in haemodynamics, functional class and exercise tolerance are comparable for both patient groups.


CONCLUSIONS
Pulmonary hypertension in children is idiopathic or associated with congenital heart disease in the majority of patients. Treatment with new selective pulmonary vasodilators offers haemodynamic and functional improvement.
De Wolf
Daniel
D
Pediatric cardiology UZ Gent, De Pintelaan 185, 9000 Gent, Belgium. daniel.dewolf@ugent.be
D030301:Activin Receptors, Type II / Q000235:genetics; D015703:Antigens, CD / Q000235:genetics; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D052006:Bone Morphogenetic Protein Receptors, Type II / Q000235:genetics; D000077300:Bosentan; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002648:Child; D004562:Electrocardiography; D000071063:Endoglin; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000453:epidemiology* / Q000235:genetics; D015994:Incidence; D010879:Piperazines / Q000627:therapeutic use*; D017354:Point Mutation / Q000235:genetics; D015995:Prevalence; D011687:Purines / Q000627:therapeutic use; D011956:Receptors, Cell Surface / Q000235:genetics; D000068677:Sildenafil Citrate; D013449:Sulfonamides / Q000627:therapeutic use*; D013450:Sulfones / Q000627:therapeutic use*; D014665:Vasodilator Agents / Q000627:therapeutic use*
D015703:Antigens, CD; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; C064206:ENG protein, human; D000071063:Endoglin; D010879:Piperazines; D011687:Purines; D011956:Receptors, Cell Surface; D013449:Sulfonamides; D013450:Sulfones; D014665:Vasodilator Agents; D000068677:Sildenafil Citrate; C425364:ACVRL1 protein, human; D030301:Activin Receptors, Type II; C498218:BMPR2 protein, human; D052006:Bone Morphogenetic Protein Receptors, Type II; D000077300:Bosentan