Use of Pulmonary Hypertension Medications in Patients with Tetralogy of Fallot with Pulmonary Atresia and Multiple Aortopulmonary Collaterals

• Published in: Pediatric cardiology Vol. 37; no. 2; pp. 304 - 312
• Main Authors: Grant, Elena K., Berger, John T.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.02.2016; Springer
• Subjects: Abnormalities, Multiple; Adolescent; Antihypertensive Agents - therapeutic use; Atresia; Bosentan; Cardiac patients; Cardiac Surgery; Cardiology; Catheterization; Child; Child, Preschool; District of Columbia; Drug therapy; Echocardiography; Endothelin; Female; Genetic disorders; Hemodynamics; Hospitals, Pediatric; Humans; Hypertension, Pulmonary - drug therapy; Infant; Infant, Newborn; Lung - physiopathology; Male; Medicine; Medicine & Public Health; Original Article; Phenylpropionates - therapeutic use; Prognosis; Pulmonary artery; Pulmonary Artery - abnormalities; Pulmonary Artery - surgery; Pulmonary Atresia - surgery; Pulmonary hypertension; Pyridazines - therapeutic use; Respiratory agents; Retrospective Studies; Sildenafil Citrate - therapeutic use; Sulfonamides - therapeutic use; Tertiary Care Centers; Tetralogy of Fallot; Tetralogy of Fallot - complications; Tetralogy of Fallot - therapy; Treprostinil; Vascular Surgery; Young Adult; Tetralogy of Fallot; Pulmonary atresia; Pulmonary hypertension; Aortopulmonary collaterals
• ISSN: 0172-0643; 1432-1971
• DOI: 10.1007/s00246-015-1278-2

Tetralogy of Fallot (TOF) with pulmonary atresia (PA) and multiple aortopulmonary collaterals (MAPCAs) is a rare and severe form of congenital heart disease with poor prognosis. Aortopulmonary collaterals expose pulmonary arterioles to systemic pressure resulting in pulmonary hypertension (PH). To date, reports regarding the role of PH medications in this population are sparse. The objective of this study was to assess the effect of PH medications in patients with TOF, PA and MAPCAs or similar anatomy, with emphasis on symptoms, echocardiography and invasive hemodynamics. A retrospective review was performed for patients at a single tertiary care pediatric center. Twelve of 66 patients were treated with PH medications (18 %), and eight of these patients had adequate follow-up for further analysis. Median age at last follow-up was 6 years (range 1.4–21 years). Median length of therapy with PH medication was 4 years (range 0.3–17 years). PH medications included sildenafil, bosentan, ambrisentan, inhaled treprostinil and prostacyclin infusion. PH therapy was associated with improvement in symptoms in all patients and improvement in PH by hemodynamic measures in the majority of patients. All patients underwent at least one cardiac intervention by catheterization or surgery while taking PH medication. Two patients died from non-PH-related causes. The remaining six patients are alive and remain on PH medication. This review indicates that PH medications are well tolerated by this patient group and provide symptomatic improvement. Further studies are required to determine whether PH medications provide long-term survival benefit for patients with complex congenital heart disease.