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Experience with long-term nifedipine therapy in paediatric cardiological patients
M Wimmer1, U Salzer, M Schlemmer
1Department of Paediatrics, University of Vienna, Austria.
Insights
Long-term nifedipine treatment improved physical performance in pediatric patients with pulmonary hypertension and congenital heart defects. Close medical supervision is recommended for initiating nifedipine therapy.
Area of Science:
- Pediatric Cardiology
- Pharmacology
- Pulmonology
Background:
- Pulmonary hypertension in children poses significant management challenges.
- Congenital heart defects often present with or lead to pulmonary hypertension.
- Nifedipine is a calcium channel blocker with potential vasodilatory effects.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of nifedipine in pediatric patients with various cardiopulmonary conditions.
- To assess the impact of nifedipine on pulmonary arterial disease progression and clinical outcomes.
Main Methods:
- A retrospective analysis of 23 pediatric patients (aged 1.75 to 14.67 years) receiving long-term nifedipine.
- Inclusion of patients with primary pulmonary hypertension, inoperable congenital heart defects with pulmonary hypertension, and operable defects with persistent pulmonary hypertension.
- Clinical assessment, echocardiography, and cardiac catheterization were used for evaluation.
Main Results:
- Subjective improvement in physical performance was noted in 15 patients.
- No progression of pulmonary arterial disease was observed, except in one severe primary pulmonary hypertension case.
- Minor side effects like flushed face and headache were reported; heart failure occurred in one Down syndrome patient.
- No complications during corrective cardiac surgeries were associated with nifedipine.
Conclusions:
- Long-term nifedipine treatment can be beneficial for improving quality of life in pediatric patients with pulmonary hypertension and inoperable defects.
- Nifedipine may reduce perioperative risk and aid in postoperative regression of pulmonary hypertension in operable defects.
- Initiation of nifedipine therapy requires strict 7-day hospital supervision, potentially with digitalization.
Abstract:
Clinical experience with long-term nifedipine treatment in 23 patients aged between 1 1/12 and 14 8/12 years is reported. The cardiopulmonary diseases comprised primary pulmonary diseases with pulmonary hypertension (n = 4), congenital heart defects with intracardiac shunts and pulmonary hypertension which either were inoperable as a result of an Eisenmenger reaction (n = 7) or presented a high surgical risk (n = 5), or defects in which pulmonary hypertension did not regress despite corrective (n = 1) or palliative surgery (n = 3), and congenital defects without pulmonary hypertension (n = 3). Subjective improvement with an increase in physical performance was clearly observed in 15 cases. Echocardiography and cardiac catheter examinations showed no progression of the pulmonary arterial diseases, except in 1 patient with severe primary pulmonary hypertension and an 11-year observation period with nifedipine treatment during the last 4 years. No complications occurred during the 4 corrective operations. A patient aged 14 8/12 years with the Down syndrome and atrioventricular septal defect developed easily controllable heart failure during 7-day administration of nifedipine without additional cardiotherapy. 4 children initially suffered from flushed face and scalp, in one case with headache; 2 children reported fatigue. Long-term treatment with nifedipine should begin with strict 7-day supervision in hospital and possibly additional digitalization. Success of the treatment was determined by an improved quality of life in patients with primary pulmonary hypertension and inoperable defects, and by a reduced perioperative risk and postoperative regression of pulmonary hypertension in patients with operable defects.