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The patient with Down syndrome and pulmonary arterial hypertension associated with congenital heart disease: from childhood to adulthood. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Pulmonary arterial hypertension (PAH) is a common complication of congenital heart disease (CHD) that significantly affects its prognosis. Down syndrome is a common comorbidity among patients with PAH associated with CHD. Children born in recent years with CHD have benefited from advances in pediatric cardiac surgery that have modified their evolution compared to adults with the same pathologies. Our objective was to know and compare the characteristics of the adult and pediatric population with DS and PAH associated with CHD.
REHAP and REHIPED are Spanish, voluntary, multicenter registries that include patients with PAH associated with CHD. REHAP started in 2007 and includes patients over 18 years of age. Patients diagnosed with PAH after this time were prospectively included, until 2021. Patients who were followed in the participating centers and diagnosed after January 1998 were retrospectively included in the registry. REHIPED started in 2009 and collects patients between 2 months and 18 years of age. Patients diagnosed with PAH after this time were prospectively included, until 2021. Patients who were followed and diagnosed after January 1998 were retrospectively included. 131 adults and 47 children with DS and PAH associated with CHD were analyzed. Their baseline characteristics, hemodynamics, treatment, and 10-year survival were compared.
Adult patients with DS presented more frequently complete atrioventricular canal defect as underlying heart disease and were mostly in Eisenmenger's situation (84%). In pediatric patients the largest group was post-repair PAH (50%). Functional class was similar in both groups, although adults presented significantly greater hemodynamic severity. Regarding medical treatment, no differences were observed between both groups: there was a very low use of prostanoids both at baseline and at follow-up, and a majority use of oral monotherapy. There were no significant differences in survival.
Corrective surgery in patients with DS has become more frequent over the years: adults are mostly in Eisenmenger's situation, while post-repair PAH is the most numerous group in children. Although adults show greater hemodynamic severity, survival is similar in both groups. Medical treatment, which showed no differences between pediatric and adult age, is very conservative, with most patients on oral monotherapy and rare use of prostanoids.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Janssen MSD
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Pulmonary arterial hypertension associated with congenital heart disease in children and adults: knowing the present to imagine the future. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction
Pulmonary arterial hypertension (PAH) is a common comorbidity in congenital heart disease (CHD) and significantly affects prognosis. Children born in recent years with CHD have benefited from advances in pediatric cardiac surgery that have modified their evolution compared to adults with the same pathologies.
Purpose
Our objective was to define and compare the characteristics of the adult and pediatric population with PAH associated with CHD.
Methods
REHAP and REHIPED are Spanish, voluntary, multicenter registries that include patients with PAH associated with CHD. REHAP started in 2007 and includes patients over 18 years of age. Patients diagnosed with PAH after this time were prospectively included, until 2020. Patients who were followed in the participating centres and diagnosed after January 1998 were retrospectively included in the registry. REHIPED started in 2009 and collects patients between 2 months and 18 years of age. Patients diagnosed with PAH after this time were prospectively included, until 2020. Patients who were followed and diagnosed after January 1998 were retrospectively included. The baseline characteristics, hemodynamic profile, treatment, and 10-year survival of the REHAP patients were compared to those included in the REHIPED. In addition, the change in the distribution of etiologies of REHAP over time was analyzed.
Results
664 patients were included from REHAP (mean age 32±20 years) and 153 from REHIPED (mean age 5±5 years). Among adults, there was a significantly higher proportion of women (67% versus 56%, p 0.004), patients with Eisenmenger syndrome and simple heart disease. The frequency of the different clinical groups has varied over the years, becoming progressively similar to the distribution observed in REHIPED. Adults presented greater hemodynamic severity, with higher mean pulmonary arterial pressure and greater pulmonary vascular resistance index. There were no differences in initial therapy or in the percentage of patients who received prostanoids at follow-up. Survival at 10 years was better in the group of children (99% at 1 year, 95% at 5 and 80% at 10) than in the adult group (94% at 1 year, 83% at 5 and 71% at 10) with a HR of 1.93 [95% CI 1.2–3] for REHAP compared to REHIPED.
Conclusions
Patients with PAH associated with CHD have different clinical and prognostic characteristics in childhood and adulthood. Knowing the characteristic of the pediatric age can help predict how the future patients with PAH associated with CHD will be and how we can plan their care.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Ferrer, MSD, Janssen, GSK Table 1Figure 1
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