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Safety, efficacy and Management of subcutaneous treprostinil infusions in the treatment of severe pediatric pulmonary hypertension.
- Source :
-
International journal of cardiology [Int J Cardiol] 2018 Aug 01; Vol. 264, pp. 153-157. Date of Electronic Publication: 2018 Mar 15. - Publication Year :
- 2018
-
Abstract
- Background: Continuous intravenous epoprostenol was the first treatment approved for pulmonary arterial hypertension (PAH) but administration through a central venous line carries risks of thrombosis and sepsis, particularly in children. We sought to evaluate the safety, efficacy and management of subcutaneous (SC) treprostinil in children with PAH.<br />Methods: Fifty-six children (median age 65, range 1-200 months) were treated with SC treprostinil. Clinical status, echocardiography, NT-proBNP, and site pain and infection were evaluated. Right heart catheterization was performed in 54 patients before starting SC treprostinil infusion and was repeated at 6 months in 31 patients.<br />Results: Treatment was well tolerated in 79% of patients. Site pain resistant to simple analgesics occurred in 12 patients (21%), but could be managed in 9/12 children. At 6 months, 3 patients had died, 4 had received a Potts shunt and 1 underwent lung transplantation. Among the 48 treated patients, 40 (83%) showed significant improvement in WHO functional class, 6 minute walk distance, NT-proBNP and pulmonary vascular resistance (p < 0.01 for all parameters). At last follow-up (median 37 months), ten patients had died, 2 underwent a lung transplantation and 8 underwent a Potts shunt. In 30 of the 36 remaining treated patients, improvement of clinical status was sustained. No children developed sepsis and 12 had minor site infections.<br />Conclusion: Subcutaneous treprostinil infusion is an effective therapy without serious side effects in children with PAH. Site pain can be managed with simple analgesics in most children.<br /> (Copyright © 2018 Elsevier B.V. All rights reserved.)
- Subjects :
- Adolescent
Antihypertensive Agents administration & dosage
Antihypertensive Agents adverse effects
Cardiac Catheterization methods
Child
Child, Preschool
Cohort Studies
Echocardiography methods
Epoprostenol administration & dosage
Epoprostenol adverse effects
Female
France
Humans
Infant
Infusions, Subcutaneous adverse effects
Infusions, Subcutaneous methods
Male
Natriuretic Peptide, Brain analysis
Peptide Fragments analysis
Retrospective Studies
Severity of Illness Index
Treatment Outcome
Analgesics administration & dosage
Epoprostenol analogs & derivatives
Hypertension, Pulmonary diagnosis
Hypertension, Pulmonary drug therapy
Hypertension, Pulmonary physiopathology
Pain, Procedural therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1874-1754
- Volume :
- 264
- Database :
- MEDLINE
- Journal :
- International journal of cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 29650343
- Full Text :
- https://doi.org/10.1016/j.ijcard.2018.03.067