Pulmonary Endarterectomy for Chronic Thromboembolic Pulmonary Hypertension in a 5-year-old Girl with No Risk Factors - A Case Report

Sudivya Sharma; Adeel Rahman; Arun Beeman; Shahin Moledina; Alex Robertson; David Jenkins; Mirjana Cvetkovic; Nagarajan Muthialu

doi:doi:10.11648/j.ajp.20220802.24

Pulmonary Endarterectomy for Chronic Thromboembolic Pulmonary Hypertension in a 5-year-old Girl with No Risk Factors - A Case Report

Sudivya Sharma, Adeel Rahman, Arun Beeman, Shahin Moledina, Alex Robertson, David Jenkins, Mirjana Cvetkovic, Nagarajan Muthialu

Published in American Journal of Pediatrics (Volume 8, Issue 2)

Received: 13 May 2022 Accepted: 31 May 2022 Published: 16 June 2022

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Abstract

Chronic thromboembolic pulmonary hypertension (CTEPH) in pediatric population is rare. We present a case of five-year-old female child, diagnosed as CTEPH on warfarin and home oxygen for 6 months. Imaging showed extensive thrombus in distal right pulmonary artery (RPA) than left pulmonary artery (LPA). She clinically deterioration inspite of maximal medical management and was referred for surgical option. Considering lack of literature evidence on surgical outcomes in pediatric CTEPH, decision to perform surgery was made after multi-disciplinary team discussion between adult and paediatric pulmonary hypertension and cardiothoracic surgical teams across two units in UK. We performed pulmonary thromboendarterectomy (PEA) using cardiopulmonary bypass under deep hypothermic circulatory arrest (DHCA). The surgical procedure was uneventful with good clinical recovery. Our report highlights the need for earlier and prompt diagnosis with a need for referral to a specialized surgical center at an earlier stage before intractable vascular resistance ensues. Surgery can be safely performed for CTEPH in pediatric populations.

Published in	American Journal of Pediatrics (Volume 8, Issue 2)
DOI	10.11648/j.ajp.20220802.24
Page(s)	132-136
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Pulmonary Endarterectomy, Pulmonary Hypertension, Chronic Thromboembolism

References

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[8]	Kim NH, Delcroix M, Jenkins DP, et al: Chronic thromboembolic pulmonary hypertension. J Am Coll Cardiol. 2013 Dec 24; 62 (25 Suppl): D92-9. doi: 10.1016/j.jacc.2013.10.024. PMID: 24355646.
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[15]	Nagaya Noritoshi, Sasaki Noriko, Ando Motomi, Sakamaki Fumio et al. Prostacyclin Therapy Before Pulmonary Thromboendarterectomy in Patients With Chronic Thromboembolic Pulmonary Hypertension. Clinical Investigations Pulmonary Circulation\| Volume 123, Issue 2, P338-343, February 01, 2003. https://doi.org/10.1378/chest.123.2.338
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APA Style

Sudivya Sharma, Adeel Rahman, Arun Beeman, Shahin Moledina, Alex Robertson, et al. (2022). Pulmonary Endarterectomy for Chronic Thromboembolic Pulmonary Hypertension in a 5-year-old Girl with No Risk Factors - A Case Report. American Journal of Pediatrics, 8(2), 132-136. https://doi.org/10.11648/j.ajp.20220802.24

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ACS Style

Sudivya Sharma; Adeel Rahman; Arun Beeman; Shahin Moledina; Alex Robertson, et al. Pulmonary Endarterectomy for Chronic Thromboembolic Pulmonary Hypertension in a 5-year-old Girl with No Risk Factors - A Case Report. Am. J. Pediatr. 2022, 8(2), 132-136. doi: 10.11648/j.ajp.20220802.24

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AMA Style

Sudivya Sharma, Adeel Rahman, Arun Beeman, Shahin Moledina, Alex Robertson, et al. Pulmonary Endarterectomy for Chronic Thromboembolic Pulmonary Hypertension in a 5-year-old Girl with No Risk Factors - A Case Report. Am J Pediatr. 2022;8(2):132-136. doi: 10.11648/j.ajp.20220802.24

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@article{10.11648/j.ajp.20220802.24,
  author = {Sudivya Sharma and Adeel Rahman and Arun Beeman and Shahin Moledina and Alex Robertson and David Jenkins and Mirjana Cvetkovic and Nagarajan Muthialu},
  title = {Pulmonary Endarterectomy for Chronic Thromboembolic Pulmonary Hypertension in a 5-year-old Girl with No Risk Factors - A Case Report},
  journal = {American Journal of Pediatrics},
  volume = {8},
  number = {2},
  pages = {132-136},
  doi = {10.11648/j.ajp.20220802.24},
  url = {https://doi.org/10.11648/j.ajp.20220802.24},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20220802.24},
  abstract = {Chronic thromboembolic pulmonary hypertension (CTEPH) in pediatric population is rare. We present a case of five-year-old female child, diagnosed as CTEPH on warfarin and home oxygen for 6 months. Imaging showed extensive thrombus in distal right pulmonary artery (RPA) than left pulmonary artery (LPA). She clinically deterioration inspite of maximal medical management and was referred for surgical option. Considering lack of literature evidence on surgical outcomes in pediatric CTEPH, decision to perform surgery was made after multi-disciplinary team discussion between adult and paediatric pulmonary hypertension and cardiothoracic surgical teams across two units in UK. We performed pulmonary thromboendarterectomy (PEA) using cardiopulmonary bypass under deep hypothermic circulatory arrest (DHCA). The surgical procedure was uneventful with good clinical recovery. Our report highlights the need for earlier and prompt diagnosis with a need for referral to a specialized surgical center at an earlier stage before intractable vascular resistance ensues. Surgery can be safely performed for CTEPH in pediatric populations.},
 year = {2022}
}

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TY  - JOUR
T1  - Pulmonary Endarterectomy for Chronic Thromboembolic Pulmonary Hypertension in a 5-year-old Girl with No Risk Factors - A Case Report
AU  - Sudivya Sharma
AU  - Adeel Rahman
AU  - Arun Beeman
AU  - Shahin Moledina
AU  - Alex Robertson
AU  - David Jenkins
AU  - Mirjana Cvetkovic
AU  - Nagarajan Muthialu
Y1  - 2022/06/16
PY  - 2022
N1  - https://doi.org/10.11648/j.ajp.20220802.24
DO  - 10.11648/j.ajp.20220802.24
T2  - American Journal of Pediatrics
JF  - American Journal of Pediatrics
JO  - American Journal of Pediatrics
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EP  - 136
PB  - Science Publishing Group
SN  - 2472-0909
UR  - https://doi.org/10.11648/j.ajp.20220802.24
AB  - Chronic thromboembolic pulmonary hypertension (CTEPH) in pediatric population is rare. We present a case of five-year-old female child, diagnosed as CTEPH on warfarin and home oxygen for 6 months. Imaging showed extensive thrombus in distal right pulmonary artery (RPA) than left pulmonary artery (LPA). She clinically deterioration inspite of maximal medical management and was referred for surgical option. Considering lack of literature evidence on surgical outcomes in pediatric CTEPH, decision to perform surgery was made after multi-disciplinary team discussion between adult and paediatric pulmonary hypertension and cardiothoracic surgical teams across two units in UK. We performed pulmonary thromboendarterectomy (PEA) using cardiopulmonary bypass under deep hypothermic circulatory arrest (DHCA). The surgical procedure was uneventful with good clinical recovery. Our report highlights the need for earlier and prompt diagnosis with a need for referral to a specialized surgical center at an earlier stage before intractable vascular resistance ensues. Surgery can be safely performed for CTEPH in pediatric populations.
VL  - 8
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Author Information

Sudivya Sharma

Department of Cardiothoracic Surgery and Cardiac Intensive Care Unit, Great Ormond Street Hospital for Children, London, United Kingdom
Adeel Rahman

Department of Cardiothoracic Surgery and Cardiac Intensive Care Unit, Great Ormond Street Hospital for Children, London, United Kingdom
Arun Beeman

Department of Cardiothoracic Surgery and Cardiac Intensive Care Unit, Great Ormond Street Hospital for Children, London, United Kingdom
Shahin Moledina

Department of Cardiothoracic Surgery and Cardiac Intensive Care Unit, Great Ormond Street Hospital for Children, London, United Kingdom
Alex Robertson

Department of Cardiothoracic Surgery and Cardiac Intensive Care Unit, Great Ormond Street Hospital for Children, London, United Kingdom
David Jenkins

Department of Cardiothoracic Surgery, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
Mirjana Cvetkovic

Department of Cardiothoracic Surgery and Cardiac Intensive Care Unit, Great Ormond Street Hospital for Children, London, United Kingdom
Nagarajan Muthialu

Department of Cardiothoracic Surgery and Cardiac Intensive Care Unit, Great Ormond Street Hospital for Children, London, United Kingdom

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APA Style

Sudivya Sharma, Adeel Rahman, Arun Beeman, Shahin Moledina, Alex Robertson, et al. (2022). Pulmonary Endarterectomy for Chronic Thromboembolic Pulmonary Hypertension in a 5-year-old Girl with No Risk Factors - A Case Report. American Journal of Pediatrics, 8(2), 132-136. https://doi.org/10.11648/j.ajp.20220802.24

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ACS Style

Sudivya Sharma; Adeel Rahman; Arun Beeman; Shahin Moledina; Alex Robertson, et al. Pulmonary Endarterectomy for Chronic Thromboembolic Pulmonary Hypertension in a 5-year-old Girl with No Risk Factors - A Case Report. Am. J. Pediatr. 2022, 8(2), 132-136. doi: 10.11648/j.ajp.20220802.24

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AMA Style

Sudivya Sharma, Adeel Rahman, Arun Beeman, Shahin Moledina, Alex Robertson, et al. Pulmonary Endarterectomy for Chronic Thromboembolic Pulmonary Hypertension in a 5-year-old Girl with No Risk Factors - A Case Report. Am J Pediatr. 2022;8(2):132-136. doi: 10.11648/j.ajp.20220802.24

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@article{10.11648/j.ajp.20220802.24,
  author = {Sudivya Sharma and Adeel Rahman and Arun Beeman and Shahin Moledina and Alex Robertson and David Jenkins and Mirjana Cvetkovic and Nagarajan Muthialu},
  title = {Pulmonary Endarterectomy for Chronic Thromboembolic Pulmonary Hypertension in a 5-year-old Girl with No Risk Factors - A Case Report},
  journal = {American Journal of Pediatrics},
  volume = {8},
  number = {2},
  pages = {132-136},
  doi = {10.11648/j.ajp.20220802.24},
  url = {https://doi.org/10.11648/j.ajp.20220802.24},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20220802.24},
  abstract = {Chronic thromboembolic pulmonary hypertension (CTEPH) in pediatric population is rare. We present a case of five-year-old female child, diagnosed as CTEPH on warfarin and home oxygen for 6 months. Imaging showed extensive thrombus in distal right pulmonary artery (RPA) than left pulmonary artery (LPA). She clinically deterioration inspite of maximal medical management and was referred for surgical option. Considering lack of literature evidence on surgical outcomes in pediatric CTEPH, decision to perform surgery was made after multi-disciplinary team discussion between adult and paediatric pulmonary hypertension and cardiothoracic surgical teams across two units in UK. We performed pulmonary thromboendarterectomy (PEA) using cardiopulmonary bypass under deep hypothermic circulatory arrest (DHCA). The surgical procedure was uneventful with good clinical recovery. Our report highlights the need for earlier and prompt diagnosis with a need for referral to a specialized surgical center at an earlier stage before intractable vascular resistance ensues. Surgery can be safely performed for CTEPH in pediatric populations.},
 year = {2022}
}

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TY  - JOUR
T1  - Pulmonary Endarterectomy for Chronic Thromboembolic Pulmonary Hypertension in a 5-year-old Girl with No Risk Factors - A Case Report
AU  - Sudivya Sharma
AU  - Adeel Rahman
AU  - Arun Beeman
AU  - Shahin Moledina
AU  - Alex Robertson
AU  - David Jenkins
AU  - Mirjana Cvetkovic
AU  - Nagarajan Muthialu
Y1  - 2022/06/16
PY  - 2022
N1  - https://doi.org/10.11648/j.ajp.20220802.24
DO  - 10.11648/j.ajp.20220802.24
T2  - American Journal of Pediatrics
JF  - American Journal of Pediatrics
JO  - American Journal of Pediatrics
SP  - 132
EP  - 136
PB  - Science Publishing Group
SN  - 2472-0909
UR  - https://doi.org/10.11648/j.ajp.20220802.24
AB  - Chronic thromboembolic pulmonary hypertension (CTEPH) in pediatric population is rare. We present a case of five-year-old female child, diagnosed as CTEPH on warfarin and home oxygen for 6 months. Imaging showed extensive thrombus in distal right pulmonary artery (RPA) than left pulmonary artery (LPA). She clinically deterioration inspite of maximal medical management and was referred for surgical option. Considering lack of literature evidence on surgical outcomes in pediatric CTEPH, decision to perform surgery was made after multi-disciplinary team discussion between adult and paediatric pulmonary hypertension and cardiothoracic surgical teams across two units in UK. We performed pulmonary thromboendarterectomy (PEA) using cardiopulmonary bypass under deep hypothermic circulatory arrest (DHCA). The surgical procedure was uneventful with good clinical recovery. Our report highlights the need for earlier and prompt diagnosis with a need for referral to a specialized surgical center at an earlier stage before intractable vascular resistance ensues. Surgery can be safely performed for CTEPH in pediatric populations.
VL  - 8
IS  - 2
ER  -

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