title: Treatment of children with pulmonary hypertension. Expert consensus statement on the diagnosis and treatment of paediatric pulmonary hypertension. The European Paediatric Pulmonary Vascular Disease Network, endorsed by ISHLT and DGPK.
abstract: Treatment of children and adults with pulmonary hypertension (PH) with or without cardiac dysfunction has improved in the last two decades. The so-called pulmonary arterial hypertension (PAH)-specific medications currently approved for therapy of adults with PAH target three major pathways (endothelin, nitric oxide, prostacyclin). Moreover, some PH centres may use off-label drugs for compassionate use. Pulmonary hypertensive vascular disease (PHVD) in children is complex, and selection of appropriate therapies remains difficult. In addition, paediatric PAH/PHVD therapy is vastly based on experience and trial data from adult rather than paediatric studies; however, the first randomised paediatric PAH trials have been conducted recently. We present consensus recommendations for the treatment of children with PH. Class of recommendation and level of evidence were assigned based on paediatric data only or on adult studies that included >10% children. After a systematic literature search and analysis of the published data, we developed treatment strategies and algorithms that can guide goal-oriented PH therapy. We discuss early combination therapy (double, triple) in patients with PAH in functional class II-IV and in those with inadequate response to the initial pharmacotherapy. In those children with progressive, severe PAH and inadequate response, advances in drug development, and interventional and surgical approaches provide promising new strategies to avoid, reverse or ameliorate right heart failure and left ventricular compression. In particular, first follow-up data indicate that Potts shunt (left pulmonary artery to descending aorta anastomosis) may be an alternative destination therapy, or bridge to bilateral lung transplantation, in end-stage paediatric PAH.
authors.affiliation: Department of Paediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Hansmann
authors.affiliation: Division of Paediatric Cardiology, Children's University Hospital Ulm, Ulm, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Apitz
mesh_terms: D000293:Adolescent; D000925:Anticoagulants / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D002648:Child; D032921:Consensus; D003276:Contraceptives, Oral / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use*; D065128:Endothelin Receptor Antagonists / Q000627:therapeutic use*; D045462:Endothelium-Dependent Relaxing Factors / Q000627:therapeutic use*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000628:therapy*; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D009569:Nitric Oxide / Q000627:therapeutic use; D010102:Oxygen Inhalation Therapy; D058986:Phosphodiesterase 5 Inhibitors / Q000627:therapeutic use*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011453:Prostaglandins / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000627:therapeutic use; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D002121:Calcium Channel Blockers; D003276:Contraceptives, Oral; D004232:Diuretics; D065128:Endothelin Receptor Antagonists; D045462:Endothelium-Dependent Relaxing Factors; D000451:Mineralocorticoid Receptor Antagonists; D058986:Phosphodiesterase 5 Inhibitors; D010975:Platelet Aggregation Inhibitors; D011453:Prostaglandins; D014665:Vasodilator Agents; D009569:Nitric Oxide; D014859:Warfarin; D001241:Aspirin