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Pediatric Arterial hypertension

Elizabeth J Thompson, Krystle Perez, Christoph P Hornik, P Brian Smith, Reese H Clark, Matthew Laughon
OBJECTIVE:  Pulmonary hypertension causes substantial morbidity and mortality in infants. Although Food and Drug Administration approved to treat pulmonary arterial hypertension in adults, sildenafil is not approved for infants. We sought to describe sildenafil exposure and associated diagnoses and outcomes in infants. STUDY DESIGN:  Retrospective cohort of neonates discharged from more than 300 neonatal intensive care units from 2001 to 2016. RESULTS:  Sildenafil was administered to 1,336/1,161,808 infants (0...
August 6, 2018: American Journal of Perinatology
Jordan D Awerbach, Richard A Krasuski, Michael G W Camitta
There are more than 1.4 million adult congenital heart disease (CHD;ACHD) patients living in the United States. Coronary artery disease (CAD) is at least as prevalent in ACHD patients as in the general population and has become a leading cause of their mortality. In the majority of cases, CAD in the ACHD population is driven by the presence of traditional cardiovascular disease (CVD) risk factors. 80% of ACHD patients have at least one CVD risk factor. Hypertension (HTN), obesity and physical inactivity are frequently seen in both pediatric and adult patients with CHD...
July 21, 2018: Progress in Cardiovascular Diseases
Na Zhu, Carrie L Welch, Jiayao Wang, Philip M Allen, Claudia Gonzaga-Jauregui, Lijiang Ma, Alejandra K King, Usha Krishnan, Erika B Rosenzweig, D Dunbar Ivy, Eric D Austin, Rizwan Hamid, Michael W Pauciulo, Katie A Lutz, William C Nichols, Jeffrey G Reid, John D Overton, Aris Baras, Frederick E Dewey, Yufeng Shen, Wendy K Chung
BACKGROUND: Pulmonary arterial hypertension (PAH) is a rare disease characterized by distinctive changes in pulmonary arterioles that lead to progressive pulmonary arterial pressures, right-sided heart failure, and a high mortality rate. Up to 30% of adult and 75% of pediatric PAH cases are associated with congenital heart disease (PAH-CHD), and the underlying etiology is largely unknown. There are no known major risk genes for PAH-CHD. METHODS: To identify novel genetic causes of PAH-CHD, we performed whole exome sequencing in 256 PAH-CHD patients...
July 20, 2018: Genome Medicine
Melanie J Dufva, Uyen Truong, Pawan Tiwari, Dunbar D Ivy, Robin Shandas, Vitaly O Kheyfets
The right ventricle and left ventricle are physically coupled through the interventricular septum. Therefore, changes in the geometry and mechanics of one ventricle can directly affect the function of the other. In treatment of pediatric pulmonary arterial hypertension, the left ventricle is often overlooked, with clinical focus primarily on improving right ventricular function. Pediatric pulmonary arterial hypertension represents a disease distinct from adult pulmonary arterial hypertension based on etiology and survival rates...
July 2018: Pulmonary Circulation
Michael Khoury, Philip R Khoury, Lawrence M Dolan, Thomas R Kimball, Elaine M Urbina
BACKGROUND AND OBJECTIVES: New pediatric hypertension definitions were recently published in a clinical practice guideline (CPG). We evaluated the impact of the CPG, compared with the previous guideline ("Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents"), on the prevalence of hypertension and associations with target organ damage (TOD) in high-risk youth. METHODS: Participants (10-18 years old) undergoing an evaluation of the cardiovascular effects of obesity and type 2 diabetes mellitus in youth were studied...
August 2018: Pediatrics
Jacopo Burrello, Elvira M Erhardt, Gaelle Saint-Hilary, Franco Veglio, Franco Rabbia, Paolo Mulatero, Silvia Monticone, Fabrizio D'Ascenzo
Pharmacological treatment is indicated in children and adolescents with hypertension unresponsive to lifestyle modifications, but there is not enough evidence to recommend 1 class of antihypertensive drugs over others. We performed a network meta-analysis to compare the results of available randomized clinical trials on pharmacological treatment of pediatric hypertension. From a total of 554 potentially relevant studies, 13 randomized placebo-controlled clinical trials enrolling ≥50 patients and a follow-up ≥4 weeks were included...
August 2018: Hypertension
Serdar Kula, Fatma Canbeyli, Vildan Atasayan, Fatma Sedef Tunaoğlu, Ayşe Deniz Oğuz
OBJECTIVE: The aim of this study was to evaluate children with pulmonary arterial hypertension (PAH) regarding epidemiological characteristics, clinical status with respect to the WHO functional class (WHO-FC), prognostic factors, and efficacy of medical treatment. METHODS: A retrospective evaluation of 41 patients with PAH was made in the Pediatric Cardiology Unit, Gazi University Medical Faculty, between February 2006 and October 2015. RESULTS: Of the 41 patients included in this study, 51...
July 2018: Anatolian Journal of Cardiology
Omar Qayum, Noor Alshami, Chizitam F Ibezim, Kimberly J Reid, Janelle R Noel-MacDonnell, Geetha Raghuveer
Atherosclerotic cardiovascular disease (CVD), a leading cause of death globally, has origins in childhood. Major risk factors include family history of premature CVD, dyslipidemia, diabetes mellitus, and hypertension. Lipoprotein (a) [Lp(a)], an inherited lipoprotein, is associated with premature CVD, but its impact on cardiovascular health during childhood is less understood. The objective of the study was to examine the relationship between Lp(a), family history of premature CVD, dyslipidemia, and vascular function and structure in a high-risk pediatric population...
June 13, 2018: Pediatric Cardiology
Susanna Desole, Manuel Jonas Richter, Alexander Heine, Ralf Ewert
No abstract text is available yet for this article.
January 1, 2018: Pulmonary Circulation
Martin Koestenberger, Alexander Avian, Andreas Gamillscheg, Hannes Sallmon, Gernot Grangl, Ante Burmas, Sabrina Schweintzger, Stefan Kurath-Koller, Gerhard Cvirn, Georg Hansmann
BACKGROUND: Echocardiographic determination of the RV end-systolic base/apex (RVESb/a) ratio was proposed to be of clinical value for the assessment of pulmonary arterial hypertension (PAH) in adults. HYPOTHESIS: We hypothesized that the RVES b/a ratio will be affected in children with PAH and aimed to correlate the RVES b/a ratio with conventionally used echocardiographic and hemodynamic variables, and with NYHA functional class (FC). METHODS: We first determined normal pediatric values for the RVES b/a ratio in 157 healthy children (68 male; age range: 0...
June 12, 2018: Clinical Cardiology
Michael Khoury, Elaine M Urbina
Atherosclerosis begins in youth and is associated with the presence of numerous modifiable cardiovascular (CV) risk factors, including hypertension. Pediatric hypertension has increased in prevalence since the 1980s but has plateaued in recent years. Elevated blood pressure levels are associated with impairments to cardiac and vascular structure and both systolic and diastolic function. Blood pressure-related increases in left ventricular mass (LVM) and abnormalities in cardiac function are associated with hard CV events in adulthood...
2018: Frontiers in Pediatrics
Helena Andrade, António Pires, Natália Noronha, Maria Emanuel Amaral, Lisete Lopes, Paula Martins, António Marinho da Silva, Eduardo Castela
In pediatric age, the prevalence of high blood pressure (BP) has increased progressively, with obesity being responsible. Despite this, the dominant etiology in this age group is renal and / or cardiovascular pathology. Ambulatory blood pressure monitoring (ABPM) is the method of choice for the diagnosis of hypertension, especially in children at high cardiovascular risk. Its use is limited to children from 5 years of age. Choosing adequated cuff size is the key to getting correct blood pressure ABPM has as main indication the confirmation of the diagnosis of hypertension...
June 2, 2018: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
Robert Louis, Daniella Levy-Erez, Anne Marie Cahill, Kevin E Meyers
BACKGROUND: Fibromuscular dysplasia (FMD) is a non-inflammatory vascular disease that in children unlike in adults shows no sex predilection. FMD is often underdiagnosed, and its pathophysiology is unclear. Delayed diagnosis may lead to refractory hypertension and decreases the chance of successful treatment. Doppler ultrasound (US), magnetic resonance angiography (MRA), computed tomography angiography (CTA), and catheter-based angiography (angiography) are currently used to help make a clinicoradiological diagnosis of FMD...
June 4, 2018: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Christiane Pees, Julian A Heno, Gabriele Häusler, Diana-Alexandra Ertl, Talin Gulesserian, Ina Michel-Behnke
Turner syndrome (TS) is a common genetic disorder in females with high incidence of ascending aortic dilatation and even dissection occurring as early as in the second decade. Known risk factors (RF) are bicuspid aortic valves (BAV), coarctation of the aorta (CoA), and arterial hypertension. Since 10% of dissections occur in patients without RF, an intrinsic aortic wall abnormality has been postulated. This study aimed to investigate the elasticity of the ascending aorta as a surrogate marker of aortic wall texture...
May 18, 2018: Heart and Vessels
Weiguang Yang, Alison L Marsden, Michelle T Ogawa, Charlotte Sakarovitch, Keeley K Hall, Marlene Rabinovitch, Jeffrey A Feinstein
Pulmonary arterial hypertension (PAH) is characterized by elevated pulmonary artery pressures (PAP) and pulmonary vascular resistance (PVR). Optimizing treatment strategies and timing for transplant remains challenging. Thus, a quantitative measure to predict disease progression would be greatly beneficial in treatment planning. We devised a novel method to assess right ventricular (RV) stroke work (RVSW) as a potential biomarker of the failing heart that correlates with clinical worsening. Pediatric patients with idiopathic PAH or PAH secondary to congenital heart disease who had serial, temporally matched cardiac catheterization and magnetic resonance imaging (MRI) data were included...
July 2018: Pulmonary Circulation
Johannes Nordmeyer, Peter Kramer, Felix Berger, Stephan Schubert
Treatment of aneurysmal lesions in the context of coarctation of the aorta (CoA) is a challenging task and these lesions are rare in children. An 11-year-old boy was incidentally diagnosed with native CoA and concomitant complex aneurysmal lesions during medical check-up for arterial hypertension. Pre-catheterization imaging was performed with computed tomography (CT), which showed a mild CoA and two native aneurysms that were juxtaposed to the origin of the left subclavian artery. For planning and guidance of the catheter procedure, image fusion software was used with an overlay from pre-registered three-dimensional reconstruction images on live fluoroscopy...
May 4, 2018: Catheterization and Cardiovascular Interventions
Gogi Kumar, Bryan Ludwig, Vipul V Patel
OBJECTIVE: Educate providers about the clinical presentation and consequences of delaying diagnosis of traumatic vertebral artery dissection with thromboembolic ischemic strokes in the pediatric population. Vertebral artery dissection is often difficult to diagnose and can be a potentially devastating cause of ischemic stroke. METHODS: Review of the chart, peer review/discussion, and imaging interpretation. RESULTS: A 16-year-old boy was admitted with confusion after a head and neck trauma was sustained while wrestling...
May 2018: Pediatric Emergency Care
Claudia Trincado, Víctor Molina, Gonzalo Urcelay, Paulina Dellepiane
INTRODUCTION: The echocardiographic evaluation of patients after heart transplantation is a useful tool. However, it is still necessary to define an optimal follow-up protocol. OBJECTIVE: To describe the results of the application of a functional echocardiographic protocol in patients being followed after pediatric heart transplantation. PATIENTS AND METHOD: Alls patients being followed at our institution after pediatric heart transplantation underwent an echocardiographic examination with a functional protocol that included global longitudinal strain...
February 2018: Revista Chilena de Pediatría
Marilyne Levy, Maria-Jesus Del Cerro, Sophie Nadaud, Karunakar Vadlamudi, Elizabeth Colgazier, Jeff Fineman, Damien Bonnet, Ian Adatia
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. 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...
August 1, 2018: International Journal of Cardiology
Dawn M Coleman, Jonathan L Eliason, James C Stanley
OBJECTIVE: Pediatric splanchnic arterial occlusive disease is uncommon and a rare cause of clinically relevant intestinal ischemia. This study was undertaken to better define the clinical manifestations and appropriate treatment of celiac artery (CA) and superior mesenteric artery (SMA) occlusive disease in children. METHODS: Clinical courses of 30 consecutive children undergoing operations for splanchnic arterial occlusive disease at the University of Michigan from 1992 to 2017 were retrospectively analyzed...
April 2, 2018: Journal of Vascular Surgery
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