Update on Perioperative Pediatric Pulmonary Hypertension Management

Rajeev S Wadia; Meghan L Bernier; Natalia M Diaz-Rodriguez; Dheeraj K Goswami; Sinead M Nyhan; Jochen Steppan

doi:10.1053/j.jvca.2021.02.055

Update on Perioperative Pediatric Pulmonary Hypertension Management

J Cardiothorac Vasc Anesth. 2022 Mar;36(3):667-676. doi: 10.1053/j.jvca.2021.02.055. Epub 2021 Feb 28.

Authors

Rajeev S Wadia¹, Meghan L Bernier², Natalia M Diaz-Rodriguez³, Dheeraj K Goswami³, Sinead M Nyhan⁴, Jochen Steppan⁵

Affiliations

¹ Department of Anesthesiology and Critical Care Medicine, Division of Pediatric Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: rwadia2@jhmi.edu.
² Department of Anesthesiology and Critical Care Medicine, Division of Pediatric Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD.
³ Department of Anesthesiology and Critical Care Medicine, Division of Pediatric Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
⁴ Department of Anesthesiology and Critical Care Medicine, Division of Adult Cardiothoracic Anesthesia, Division of Adult Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
⁵ Department of Anesthesiology and Critical Care Medicine, Division of Pediatric Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Anesthesiology and Critical Care Medicine, Division of Adult Cardiothoracic Anesthesia, Division of Adult Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.

PMID: 33781669
DOI: 10.1053/j.jvca.2021.02.055

Abstract

Pediatric pulmonary hypertension is a disease that has many etiologies and can present anytime during childhood. Its newly revised hemodynamic definition follows that of adult pulmonary hypertension: a mean pulmonary artery pressure >20 mmHg. However, the pediatric definition stipulates that the elevated pressure must be present after the age of three months. The definition encompasses many different etiologies, and diagnosis often involves a combination of noninvasive and invasive testing. Treatment often is extrapolated from adult studies or based on expert opinion. Moreover, although general anesthesia may be required for pediatric patients with pulmonary hypertension, it poses certain risks. A thoughtful, multidisciplinary approach is needed to deliver excellent perioperative care.

Keywords: children; pulmonary hypertension; surgery.

Publication types

Review

MeSH terms

Adult
Anesthesia, General
Child
Hemodynamics
Humans
Hypertension, Pulmonary* / diagnosis
Hypertension, Pulmonary* / therapy
Infant
Perioperative Care