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Unique Pulmonary Hypertension in Young Children: A Case Series Study
I-Chen Chen1,2,3, Hsiu-Lin Chen1,2,4, Yi-Ching Liu1
1Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan.
Insights
Pediatric pulmonary hypertension (PH) presents unique challenges due to comorbidities and developmental issues. This study reviews pediatric PH cases, highlighting the need for age-specific classifications beyond adult standards.
Area of Science:
- Pediatrics
- Cardiology
- Pulmonology
Background:
- Pediatric pulmonary hypertension (PH) shares clinical features with adult PH but involves unique disorders and challenges.
- Advances in neonatal care have revealed novel pulmonary vascular diseases in children.
- Pediatric PH can originate in utero, leading to persistent vascular growth abnormalities.
Purpose of the Study:
- To retrospectively review unique pediatric PH cases treated between 2000 and 2020.
- To analyze the diverse comorbidities associated with pediatric PH.
- To evaluate the applicability of adult PH classification systems to pediatric cases.
Main Methods:
- Retrospective review of pediatric PH cases at a tertiary teaching hospital.
- Recording of clinical profiles, comorbidities, radiological findings, echocardiography, and pulmonary angiograms.
- Classification of cases using the Panama classification and the Sixth World Symposium on PH criteria.
Main Results:
- Identified varied comorbidities including surfactant dysfunction, bronchopulmonary dysplasia, and premature ductal closure.
- Observed complex and age-dependent underlying causes of pediatric PH.
- Found adult PH classifications may not fully apply to pediatric cases.
Conclusions:
- Pediatric PH requires a specialized approach due to its unique etiology and comorbidities.
- Existing adult PH classification systems may need adaptation for pediatric populations.
- Further research is needed to refine diagnostic and therapeutic strategies for pediatric PH.
Abstract:
Pediatric pulmonary hypertension (PH) has a similar clinical presentation to the adult disease but is associated with several additional disorders and challenges that require a specific approach for their fulminant course. With improved care for premature infants, various forms of pulmonary vascular disease have been found in children that did not previously exist. Pediatric PH can begin in utero, resulting in pulmonary vascularity growth abnormalities that may persist into adulthood. Here, we retrospectively reviewed several unique pediatric PH cases from 2000 to 2020 at Kaohsiung Medical University Hospital, Taiwan, a tertiary teaching hospital. Their comorbidities varied and included surfactant dysfunction, bronchopulmonary dysplasia, premature closure of the ductus arteriosus, high levels of renin and aldosterone, and Swyer-James-Macleod syndrome. Their clinical profiles, radiological characteristics, echocardiography, pulmonary angiogram, and therapeutic regimens were recorded. Further, because the underlying causes of pediatric PH were complex and markedly different according to age, adult PH classification may not be applicable to pediatric PH in all settings. We also classified these cases using different systems, including the Panama classification and the Sixth World Symposium on PH, and compared their advantages and disadvantages.
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