05 February 2018 by Gabriel Diaz

Is pulmonary hypertension (ph) in children at altitude different in relation with ph in children at low altitude or sea level?

Introduction

Above 2.500 meters over sea level (MOSL), hypobaric hypoxia is significant. However, the results of studies on PH at sea level are extrapolated to children with PH in altitude.

Objective

To show our experience in the last two years with children with severe PH studied in Bogotá (2.640 MOSL), looking to show that PH in children at altitude is different to PH in children at sea level.

Materials and Methods

We include children with severe PH studied within the last two years. Patients had complete study of PH including catheterism, BNP and 6MWT (children over 3 years old). Hyperoxia is used as reactivity test in adition to NO. Patients are recommended to live at low altitude.

Results

26 new patients were studied; 40% 4 years old or younger; 69% females; 60% had IPH; 3 developed severe PH after ductus closure (2 with Down Syndrome). Majority underwent combined treatment: Syldenafil-bosentan, syldenafil-macitentan and two with syldenafil-macitetan-treprostinil (FC III). Other patients are in FC II. One patient died (Down with Ductus closure at 6 months old). The majority are better. Median of mean Pulmonary pressure: 60 mm Hg and PR around 20 UW

Discusion

Population of Bogotá is around 9.500.000; We cover only a small part; maybe there is subdiagnosis indicating that the frequency is high. PH is severe at younger ages with important hyperreactivity of PV. Due to hypobaric Hypoxia, oxygen is important in diagnosis and it’s important to live at low altitude.

Conclusion

PH of children in altitude is different to PH of children at sea level in: Frequency: 1.1 new patients every month; severity at early age. Biopathogenesis: Hypobaric Hypoxia. Diagnosis: Role of Oxygen in VRT. Treatment: Important to live at low altitude.
PH in altitude deserves to be a special subgroup of Niza GROUP 3 ?

Key Contributors

Gabriel Díaz, Alicia Márquez, Roy Sanguino, Manuel Huertas, Miguel Ronderos and Oscar Arévalo Universidad Nacional de Colombia, CPO, Fundación CardioInfantil


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