title: Pediatric pulmonary arterial hypertension: current and emerging therapeutic options.
abstract: BACKGROUND
  Pulmonary arterial hypertension (PAH) is a rare disease in neonates, infants and children that is associated with significant morbidity and mortality. An adequate understanding of the controlling pathophysiologic mechanisms is lacking and although mortality has decreased as therapeutic options have increased over the past several decades, outcomes remain unacceptable.
  
  
  METHODS
  This review summarizes the currently available therapies for neonates, infants and children with PAH and describes emerging therapies in the context of what is known about the underlying pathophysiology of the disease.
  
  
  CONCLUSIONS
  All of the currently approved PAH therapies impact one of three endothelial-based pathways: nitric oxide-guanosine-3'-5'cyclic monophosphate, prostacyclin or endothelin-1. The beneficial effects of these agents may relate to their impact on pulmonary vascular tone, and/or their antiproliferative and antithrombotic properties. Fundamental advances in PAH therapy are likely to relate to: i) a better understanding of PAH subpopulations, allowing for therapies to be better tailored to individual patients and pathophysiologic processes; and ii) therapies that promote the regression of advanced structural remodeling.
authors: Cardiovascular Research Institute, Division of Critical Care Medicine, University of California-San Francisco, 513 Parnassus Avenue, San Francisco, CA 94143-1346, USA. oiship@peds.ucsf.edu
authors: Peter
authors: P
authors: Oishi
authors: Sanjeev A
authors: SA
authors: Datar
authors: Jeffrey R
authors: JR
authors: Fineman