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Gavotto A, Amedro P, Cambonie G. Think out of the box: association of left congenital diaphragmatic hernia and abnormal origin of the right pulmonary artery : A train can hide another. BMC Pediatr 2023; 23:349. [PMID: 37434143 DOI: 10.1186/s12887-023-04164-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/28/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND We report the occurrence of a severe pulmonary hypertension (PH) in a neonate affected by a left congenital diaphragmatic hernia (CDH). PH in this patient was associated with an abnormal origin of the right pulmonary artery from the right brachiocephalic artery. This malformation, sometimes named hemitruncus arteriosus, has to the best of our knowledge never been reported in association with a CDH. CASE PRESENTATION A male newborn was hospitalized from birth in the neonatal intensive care unit after prenatal diagnosis of a left CDH. Ultrasound examination at 34 weeks of gestational age evaluated the observed-to-expected lung-to-head ratio at 49%. Birth occurred at 38+ 5 weeks of gestational age. Soon after admission, severe hypoxemia, i.e., preductal pulse oximetry oxygen saturation (SpO2) < 80%, prompted therapeutic escalation including the use of high frequency oscillatory ventilation with fraction of inspired oxygen (FiO2) 100% and inhaled nitric oxide (iNO). Echocardiography assessment revealed signs of severe PH and normal right ventricle function. Despite administration of epoprostenolol, milrinone, norepinephrine, and fluid loadings with albumin and 0.9% saline, hypoxemia remained severe, preductal SpO2 inconsistently greater than or equal to 80-85% and post ductal SpO2 lower on average by 15 points. This clinical status remained unchanged during the first 7 days of life. The infant's clinical instability was incompatible with surgical intervention, while chest X-ray showed a relatively preserved lung volume, especially on the right side. This prompted an additional echocardiography, aimed at searching an explanation of this unusual evolution and found an abnormal origin of the right pulmonary artery, which was confirmed on computed tomography angiography subsequently. A change in the medical strategy was decided, with the suspension of pulmonary vasodilator treatments, the administration of diuretics, and the decrease in norepinephrine dose to decrease the systemic-to-pulmonary shunt. Progressive improvement in the infant respiratory and hemodynamic status enabled to perform CDH surgical repair 2 weeks after birth. CONCLUSIONS This case recalls the interest of systematic analysis of all potential causes of PH in a neonate with CDH, a condition frequently associated with various congenital malformations.
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Affiliation(s)
- Arthur Gavotto
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France.
- PhyMedExp, CNRS, INSERM, University of Montpellier, Montpellier, France.
| | - Pascal Amedro
- Paediatric and Congenital Cardiology Department, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux, France
- IHU Liryc, INSERM 1045, Bordeaux University, Bordeaux, France
| | - Gilles Cambonie
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France
- Pathogenesis and Control of Chronic Infection, INSERM UMR 1058, University of Montpellier, Montpellier, France
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Li L, Zhu X, Chen X, Gao J, Ding C, Zhang M, Ma S. Advances in targeted therapy for pulmonary arterial hypertension in children. Eur J Pediatr 2023; 182:2067-2076. [PMID: 36527480 DOI: 10.1007/s00431-022-04750-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 11/29/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022]
Abstract
Pulmonary arterial hypertension (PAH) is a rare and devastating disease of the pulmonary vasculature with a high morbidity and mortality rate in infants and children. Currently, treatment approaches are mostly based on adult guidelines and pediatrician clinical experience, focusing on specific pulmonary antihypertensive therapy and conventional supportive care. The advent of targeted drugs has led to significant advances in the treatment of PAH in children, including endothelin receptor antagonists, phosphodiesterase type 5 inhibitors, and prostacyclins, which have been studied and proven to improve hemodynamics and functional class in children PAH. A new targeted drug, riociguat, is assessing its safety and efficacy in clinical trials. However, more randomized controlled studies are needed to evaluate the combination of drugs, treatment strategies, and clinical endpoints of targeted therapy in children PAH. In this review, we summarize the research advances of PAH-targeted therapy in children over the last decade in order to provide a theoretical basis for future studies. CONCLUSION Pulmonary arterial hypertension (PAH) is a rare and devastating pulmonary vascular disease that is associated with a variety of diseases of any age in childhood onset. WHAT IS KNOWN • Therapeutic strategies for targeted drugs for PAH in children are based almost exclusively on data from adult studies and clinical experience of pediatric specialists. • Due to the complex etiology of PAH in children and the relative lack of clinical trial data, the selection of appropriate targeted drug therapy remains difficult. WHAT IS NEW • We redefine the definition of pulmonary arterial hypertension in children and summarize the progress of targeted therapy of pulmonary arterial hypertension in children in the past ten years. • The dosage and adverse reactions were summarized, and the mechanism of action was drawn according to the available targeted drugs. It can provide theoretical support for the development of guidelines and treatment strategies for the diagnosis and treatment of pulmonary arterial hypertension in children.
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Affiliation(s)
- Li Li
- Department of Scientific Research, Gansu Provincial Hospital, 204 West Donggang R.D., Lanzhou, 730000, China
| | - Xinyu Zhu
- Department of Scientific Research, Gansu Provincial Hospital, 204 West Donggang R.D., Lanzhou, 730000, China
| | - Xiaojie Chen
- Department of Scientific Research, Gansu Provincial Hospital, 204 West Donggang R.D., Lanzhou, 730000, China
| | - Jieyun Gao
- Department of Scientific Research, Gansu Provincial Hospital, 204 West Donggang R.D., Lanzhou, 730000, China
| | - Chunchun Ding
- Department of Pharmacy, Gansu Provincial Hospital, 204 West Donggang R.D., Lanzhou, 730000, China
| | - Min Zhang
- Department of Scientific Research, Gansu Provincial Hospital, 204 West Donggang R.D., Lanzhou, 730000, China.
| | - Shixun Ma
- First Clinical College of Medicine, Lanzhou University, 1st West Donggang R.D., Lanzhou, 730000, China.
- General Surgery, Gansu Provincial Hospital, 204 West Donggang R.D., Lanzhou, 730000, China.
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Pommier V, Abassi H, Lavastre K, Calderon J, Guillaumont S, Dulac Y, Auriol F, Ovaert C, Blondelon A, Hascoet S, Lecerf F, Jore C, Avesani M, Thambo JB, Amedro P. Impact of COVID-19 disease on clinical research in pediatric and congenital cardiology. Arch Pediatr 2022; 29:347-353. [PMID: 35523633 PMCID: PMC9020482 DOI: 10.1016/j.arcped.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 02/21/2022] [Accepted: 03/26/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND COVID-19 triggered an unprecedented crisis affecting society at every level. Research in pediatric and congenital cardiology is currently in full development and may have been disrupted. The aim of the study was to determine the impact of COVID-19 on pediatric and congenital cardiology clinical research and to analyze decision-making and adaptation processes, from a panel of ongoing academic and industry-sponsored research at the time of the pandemic. METHODS This observational study was carried out in April 2020, from a CHD clinical research network involving five tertiary care pediatric and congenital cardiology centers. Investigators and clinical research assistants from each participating research center completed an online survey questionnaire, and each principal investigator underwent a 1-h web-based videoconference interview. RESULTS A total of 34 study questionnaires were collected, reporting that 18 studies were totally suspended. Upon the investigator's decision, after discussion on ethical issues and with facilitating support from health authorities, 16 studies were resumed. The rate of study suspension in interventional research (53%) was similar to that in non-interventional research (56%). Logistical problems were predominantly reported in both continued and suspended trials. Research protocols were adapted, largely thanks to telemedicine, which in some cases even improved the course of the study. CONCLUSION The impact of the COVID-19 pandemic on clinical research in pediatric and congenital cardiology has been limited by a rapid adaptation of all research structures and an extensive use of telemedicine at all stages of the studies.
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Affiliation(s)
- V. Pommier
- Pediatric and Congenital Cardiology Department, M3C Regional Reference Centre, Clinical Investigation Centre, University Hospital, Montpellier, France
| | - H. Abassi
- Pediatric and Congenital Cardiology Department, M3C Regional Reference Centre, Clinical Investigation Centre, University Hospital, Montpellier, France,PhyMedExp, CNRS, INSERM, University of Montpellier, Montpellier, France
| | - K. Lavastre
- Pediatric and Congenital Cardiology Department, M3C Regional Reference Centre, Clinical Investigation Centre, University Hospital, Montpellier, France
| | - J. Calderon
- Pediatric and Congenital Cardiology Department, M3C Regional Reference Centre, Clinical Investigation Centre, University Hospital, Montpellier, France,PhyMedExp, CNRS, INSERM, University of Montpellier, Montpellier, France,Cardiac Neurodevelopmental Program, Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - S. Guillaumont
- Pediatric and Congenital Cardiology Department, M3C Regional Reference Centre, Clinical Investigation Centre, University Hospital, Montpellier, France,Pediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France
| | - Y. Dulac
- Pediatric and Congenital Cardiology Department, M3C Regional Reference Centre, Toulouse University Hospital, Toulouse CIC 1436, France
| | - F. Auriol
- Pediatric and Congenital Cardiology Department, M3C Regional Reference Centre, Toulouse University Hospital, Toulouse CIC 1436, France
| | - C. Ovaert
- Pediatric and Congenital Cardiology Department, M3C Regional Reference Centre, APHM La Timone University Hospital, Marseille, France
| | - A. Blondelon
- Pediatric and Congenital Cardiology Department, M3C Regional Reference Centre, APHM La Timone University Hospital, Marseille, France
| | - S. Hascoet
- Pediatric and Congenital Cardiology Department, M3C National Reference Centre, Centre Medico-Chirurgical Marie-Lannelongue, Le Plessis-Robinson, France
| | - F. Lecerf
- Pediatric and Congenital Cardiology Department, M3C National Reference Centre, Centre Medico-Chirurgical Marie-Lannelongue, Le Plessis-Robinson, France
| | - C. Jore
- Pediatric and Congenital Cardiology Department, M3C National Reference Centre, Bordeaux University Hospital, Avenue de Magellan, Bordeaux 33604, France
| | - M. Avesani
- Pediatric and Congenital Cardiology Department, M3C National Reference Centre, Bordeaux University Hospital, Avenue de Magellan, Bordeaux 33604, France
| | - J.-B. Thambo
- Pediatric and Congenital Cardiology Department, M3C National Reference Centre, Bordeaux University Hospital, Avenue de Magellan, Bordeaux 33604, France,IHU Liryc, Electrophysiology and Heart Modelling Institute, INSERM 1045, Bordeaux University Foundation, Pessac, France
| | - P. Amedro
- Pediatric and Congenital Cardiology Department, M3C National Reference Centre, Bordeaux University Hospital, Avenue de Magellan, Bordeaux 33604, France,IHU Liryc, Electrophysiology and Heart Modelling Institute, INSERM 1045, Bordeaux University Foundation, Pessac, France,Corresponding author
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Chen X, Cai XM, Zhang MJ, Xu JH, Li H, Xu ZM. Pharmacokinetics of treprostinil in children with functional single-ventricle pulmonary arterial hypertension: a randomized controlled trial. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1163. [PMID: 34430604 PMCID: PMC8350654 DOI: 10.21037/atm-21-3188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/14/2021] [Indexed: 12/22/2022]
Abstract
Background Application of Treprostinil (TRE) in the patients with single ventricle (SV) physiology is very limited, and the optimal dose for children has not been determined. In this study, we aimed to analyze plasma samples to assess the attainment of clinically therapeutic concentrations of TRE and its efficacy and safety in the treatment of pediatric functional SV pulmonary arterial hypertension (FSV-PAH).. Methods Pediatric patients with FSV-PAH were recruited in this study. IV TRE at an initial rate of 5 ng/kg/min was administered through the femoral vein with an increase in rate to 10 ng/kg/min every 30 minuntil the aiming dose of 80 ng/kg/min had been reached. The drug was gradually discontinued after 12 h of treatment at a stable dose. The mean postoperative pulmonary artery pressure (mPAP), pulmonary-to-systemic arterial pressure ratio (Pp/Ps), and the ratio between arterial oxygen partial pressure and inhaled oxygen concentration (PaO2/FiO2) were used to evaluate the efficacy of TRE treatment. A multiple linear regression model was used to explore the relevant factors associated with TRE blood concentration. Results A total of eight patients were enrolled in the investigation, with an age range of 2.5-9.9 years. The median stable dose of TRE was 70 ng/kg/min with a range of 55-75 ng/kg/min. The median subliminal dose was 55 ng/kg/min with a range of 25-75 ng/kg/min. A linear relationship was established between the TRE dose and the plasma concentration. TRE blood concentrations were associated with dose and patient height. After TRE treatment, mPAP, Pp/Ps, and PaO2/FiO2 were significantly improved (P<0.05). Conclusions A linear relationship was found between the blood concentration of TRE and its dose. IV TRE was an effective therapy without serious side effects in pediatric patients with FSV-PAH. Trial Registration ClinicalTrials.gov Identifier: NCT02865733.
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Affiliation(s)
- Xi Chen
- Department of Thoracic and Cardiovascular Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiao-Man Cai
- Department of Thoracic and Cardiovascular Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ming-Jie Zhang
- Department of Thoracic and Cardiovascular Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jing-Han Xu
- Department of Pharmacy, Clinical Research Center, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hao Li
- Department of Pharmacy, Clinical Research Center, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhuo-Ming Xu
- Department of Thoracic and Cardiovascular Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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