Pulmonary endarterectomy in a 12-year-old boy with multiple comorbidities
A 10-year-old boy, with multiple comorbidities presented with fever, exertional dyspnea, fatigue and an obliterated brachiocephalic and inferior caval vein. Chronic thromboembolic pulmonary hypertension (CTEPH) was diagnosed. Nadroparine, antibiotics and supplemental oxygen were successfully started...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2019-11-01
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| Series: | Pulmonary Circulation |
| Online Access: | https://doi.org/10.1177/2045894019886249 |
| _version_ | 1811329925960957952 |
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| author | Tom Verbelen Bjorn Cools Zina Fejzic Raf Van Den Eynde Geert Maleux Marion Delcroix Bart Meyns |
| author_facet | Tom Verbelen Bjorn Cools Zina Fejzic Raf Van Den Eynde Geert Maleux Marion Delcroix Bart Meyns |
| author_sort | Tom Verbelen |
| collection | DOAJ |
| description | A 10-year-old boy, with multiple comorbidities presented with fever, exertional dyspnea, fatigue and an obliterated brachiocephalic and inferior caval vein. Chronic thromboembolic pulmonary hypertension (CTEPH) was diagnosed. Nadroparine, antibiotics and supplemental oxygen were successfully started. Aged 12 years, supplemental oxygen was permanently needed with progressive exertional dyspnea and fatigue. In the country of residence the patient was considered as inoperable. The right ventricle was severely dilated, hypocontractile and hypertrophic. Mean pulmonary artery pressure (mPAP) was 79 mmHg and cardiac output 2.2 L/min. Pulmonary endarterectomy was uneventful. Four days later, mPAP was 33 mmHg and cardiac output 6.4 L/min. Three months later the boy restarted his education without supplemental oxygen. Six months after surgery right ventricular size and function and mPAP (14 mmHg) were normal. We demonstrated that pulmonary endarterectomy in young aged children is feasible and well-tolerated, even in the presence of severe co-morbidities. CTEPH should be an important diagnostic consideration in symptomatic children with a known hypercoaguable state, a history of thrombo-embolism or venous catheter placement, and/or a diagnosis of pulmonary hypertension. Hesitating to refer children for surgical consideration, or attempting to treat them by medication, only postpones the single potentially curable treatment and may worsen their prognosis. |
| first_indexed | 2024-04-13T15:53:33Z |
| format | Article |
| id | doaj.art-e5638b8039234bf08743477f866dad8f |
| institution | Directory Open Access Journal |
| issn | 2045-8940 |
| language | English |
| last_indexed | 2024-04-13T15:53:33Z |
| publishDate | 2019-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Pulmonary Circulation |
| spelling | doaj.art-e5638b8039234bf08743477f866dad8f2022-12-22T02:40:47ZengWileyPulmonary Circulation2045-89402019-11-01910.1177/2045894019886249Pulmonary endarterectomy in a 12-year-old boy with multiple comorbiditiesTom Verbelen0Bjorn Cools1Zina Fejzic2Raf Van Den Eynde3Geert Maleux4Marion Delcroix5Bart Meyns6Department of Cardiac Surgery, University Hospitals Leuven, Leuven, BelgiumDepartment of Pediatric Cardiology, University Hospitals Leuven, Leuven, BelgiumChildren's Heart Center, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the NetherlandsDepartment of Anesthesiology, University Hospitals Leuven, Leuven, BelgiumDepartment of Radiology, University Hospitals Leuven, Leuven, BelgiumDepartment of Pneumology, University Hospitals Leuven, Leuven, BelgiumDepartment of Cardiac Surgery, University Hospitals Leuven, Leuven, BelgiumA 10-year-old boy, with multiple comorbidities presented with fever, exertional dyspnea, fatigue and an obliterated brachiocephalic and inferior caval vein. Chronic thromboembolic pulmonary hypertension (CTEPH) was diagnosed. Nadroparine, antibiotics and supplemental oxygen were successfully started. Aged 12 years, supplemental oxygen was permanently needed with progressive exertional dyspnea and fatigue. In the country of residence the patient was considered as inoperable. The right ventricle was severely dilated, hypocontractile and hypertrophic. Mean pulmonary artery pressure (mPAP) was 79 mmHg and cardiac output 2.2 L/min. Pulmonary endarterectomy was uneventful. Four days later, mPAP was 33 mmHg and cardiac output 6.4 L/min. Three months later the boy restarted his education without supplemental oxygen. Six months after surgery right ventricular size and function and mPAP (14 mmHg) were normal. We demonstrated that pulmonary endarterectomy in young aged children is feasible and well-tolerated, even in the presence of severe co-morbidities. CTEPH should be an important diagnostic consideration in symptomatic children with a known hypercoaguable state, a history of thrombo-embolism or venous catheter placement, and/or a diagnosis of pulmonary hypertension. Hesitating to refer children for surgical consideration, or attempting to treat them by medication, only postpones the single potentially curable treatment and may worsen their prognosis.https://doi.org/10.1177/2045894019886249 |
| spellingShingle | Tom Verbelen Bjorn Cools Zina Fejzic Raf Van Den Eynde Geert Maleux Marion Delcroix Bart Meyns Pulmonary endarterectomy in a 12-year-old boy with multiple comorbidities Pulmonary Circulation |
| title | Pulmonary endarterectomy in a 12-year-old boy with multiple comorbidities |
| title_full | Pulmonary endarterectomy in a 12-year-old boy with multiple comorbidities |
| title_fullStr | Pulmonary endarterectomy in a 12-year-old boy with multiple comorbidities |
| title_full_unstemmed | Pulmonary endarterectomy in a 12-year-old boy with multiple comorbidities |
| title_short | Pulmonary endarterectomy in a 12-year-old boy with multiple comorbidities |
| title_sort | pulmonary endarterectomy in a 12 year old boy with multiple comorbidities |
| url | https://doi.org/10.1177/2045894019886249 |
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