title: Understanding and treating pulmonary hypertension in congenital diaphragmatic hernia.
abstract: Lung hypoplasia and pulmonary hypertension are classical features of congenital diaphragmatic hernia (CDH) and represent the main determinants of survival. The mechanisms leading to pulmonary hypertension in this malformation are still poorly understood, but may combine altered vasoreactivity, pulmonary artery remodeling, and a hypoplastic pulmonary vascular bed. Efforts have been directed at correcting the "reversible" component of pulmonary hypertension of CDH. However, pulmonary hypertension in CDH is often refractory to pulmonary vasodilators. A new emerging pattern of late (months after birth) and chronic (months to years after birth) pulmonary hypertension are described in CDH survivors. The true incidence and implications for outcome and management need to be confirmed by follow-up studies from referral centers with high patient output. In order to develop more efficient strategies to treat pulmonary hypertension and improve survival in most severe cases, the ultimate therapeutic goal would be to promote lung and vascular growth.
authors.affiliation: Ottawa Hospital Research Institute, Regenerative Medicine Program, Sprott Center for Stem Cell Research, Department of Pediatrics, Division of Neonatology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada. Electronic address: mpierro@cheo.on.ca.
authors.forename: M
authors.initials: M
authors.lastname: Pierro
authors.affiliation: Ottawa Hospital Research Institute, Regenerative Medicine Program, Sprott Center for Stem Cell Research, Department of Pediatrics, Division of Neonatology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada.
authors.forename: B
authors.initials: B
authors.lastname: Thébaud
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D015199:Extracorporeal Membrane Oxygenation; D065630:Hernias, Diaphragmatic, Congenital / Q000150:complications*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000151:congenital / Q000628:therapy*; D008168:Lung / Q000002:abnormalities
chemical_list: D000959:Antihypertensive Agents
keywords: Congenital diaphragmatic hernia; Lung hypoplasia; Prenatal therapy; Pulmonary hypertension; Vasodilator therapy