Skip to main content
SpringerLink
Log in

Etiology, Diagnosis, and Pharmacologic Treatment of Pediatric Pulmonary Hypertension

  • Review Article
  • Published:
Pediatric Drugs Aims and scope Submit manuscript

Abstract

Major advances have been made in the understanding and treatment of pulmonary hypertension in the last few years. Without treatment (medication) for idiopathic pulmonary arterial hypertension, which is a rare and potentially fatal condition, the survival time is only about 3 years after diagnosis. However, if pulmonary hypertension is secondary to other causes such as congenital heart disease, it is possible to survive for 30 years or more without treatment.

The condition can affect children at any age, from fetal life to adulthood. Patients with pulmonary hypertension can present to the respiratory pediatrician with unresponsive asthma, to the neurologist with faints, or to the general pediatrician with failure to thrive.

Over the last few years there have been significant developments in the available therapy for managing this complicated disease. There is now a generally recognized ladder of long-term therapy for chronic pulmonary hypertension. Treatment can start with oxygen at home at night or even during the day. Next is the use of oral phosphodiesterase inhibitors, mostly type V, such as sildenafil, which enhance endogenous nitric oxide. More potent are the endothelin receptor antagonists and the most potent are the prostanoids, especially epoprostenol, which is given by constant intravenous infusion. In addition to interventional catheterization with atrial septostomy, these agents have improved the prognostic outlook. This article reviews the current knowledge about the etiology, investigation, and treatment of children with pulmonary hypertension in the clinical setting.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I
Table II
Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Table III

Similar content being viewed by others

References

  1. Wood P. The Eisenmenger syndrome or pulmonary hypertension with reversed central shunt. BMJ 1958; 2: 701–9

    Article  PubMed  CAS  Google Scholar 

  2. Dresdale DT, Schultz M, Michtom RJ. Primary pulmonary hypertension: I. Clinical and hemodynamic study. Am J Med 1951; 11(6): 686–705

    Article  PubMed  CAS  Google Scholar 

  3. Eisenmenger V. Die angeboren defects des kammerscheidewand des herzen. Z Klin Med 1897; 32: 1–28

    Google Scholar 

  4. Heath D, Edwards J. A description of six grades of structural changes in the pulmonary arteries with special reference to congenital cardiac defects. Circulation 1958; 18: 533–47

    Article  PubMed  CAS  Google Scholar 

  5. Rabinovitch M, Keane J, Norwood W. Vascular structure in lung tissue obtained at biopsy correlated with pulmonary haemodynamic findings after repair of congenital heart defects. Circulation 1984; 69: 655–67

    Article  PubMed  CAS  Google Scholar 

  6. Rabinovitch M. Pathobiology of pulmonary hypertension: impact on clinical management. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2000; 3: 63–81

    PubMed  Google Scholar 

  7. Rubin LJ. Pulmonary arterial hypertension. Proc Am Thorac Soc 2006; 3(1): 111–5

    Article  PubMed  CAS  Google Scholar 

  8. Andrews R, Tulloh R. Pulmonary hypertension in paediatrics. Curr Opin Ped 2002; 14: 603–5

    Google Scholar 

  9. Kovesi T, Abdurahman A, Blayney M. Elevated carbon dioxide tension as a predictor of subsequent adverse events in infants with bronchopulmonary dysplasia. Lung 2006; 184(1): 7–13

    Article  PubMed  CAS  Google Scholar 

  10. Gibbs J. Recommendations on the management of pulmonary hypertension in clinical practice. Heart 2001; 86Suppl. 1: 1–13

    Google Scholar 

  11. Proceedings of the 3rd World Symposium on Pulmonary Arterial Hypertension, Venice, Italy, 23–25 Jun 2003. J Am Coll Cardiol 2004; 43(12 Suppl. S): 1S–90S

    Google Scholar 

  12. Simonneau G, Galie N, Rubin LJ, et al. Clinical classification of pulmonary hypertension. J Am Coll Cardiol 2004; 43(12 Suppl. S): 5S–12S

    Article  PubMed  Google Scholar 

  13. Abman SH. Pathogenesis and treatment of neonatal and postnatal pulmonary hypertension. Curr Opin Pediatr 1994; 6(3): 239–47

    Article  PubMed  CAS  Google Scholar 

  14. Humbert M, Nunes H, Sitbon O, et al. Risk factors for pulmonary arterial hypertension. Clin Chest Med 2001; 22(3): 459–75

    Article  PubMed  CAS  Google Scholar 

  15. Luchese S, Manica JL, Zielinsky P. Intrauterine ductus arteriosus constriction: analysis of a historic cohort of 20 cases. Arq Bras Cardiol 2003; 81(4): 405–10, 399–404

    Article  PubMed  Google Scholar 

  16. Carlo WF, Villamor E, Ambalavanan N, et al. Chronic exposure to cigarette smoke extract impairs endothelium-dependent relaxation of chicken embryo pulmonary arteries. Biol Neonate 2001; 80(3): 247–50

    Article  PubMed  CAS  Google Scholar 

  17. Chambers CD, Hernandez-Diaz S, Li VM, et al. Selective serotonin-reuptake inhibitors and risk of persistent pulmonary hypertension of the newborn. N Engl J Med 2006; 354: 579–87

    Article  PubMed  CAS  Google Scholar 

  18. Rosenzweig EB, Barst RJ. Eisenmenger’s syndrome: current management. Prog Cardiovasc Dis 2002; 45: 129–38

    Article  Google Scholar 

  19. Andrews R, Tulloh R, Magee A, et al. Atrial septal defect with failure to thrive in infancy: hidden pulmonary vascular disease? Pediatr Cardiol 2002; 23(5): 528–30

    PubMed  Google Scholar 

  20. Haworth SG. Development of the normal and hypertensive pulmonary vasculature. Exp Physiol 1995; 80(5): 843–53

    PubMed  CAS  Google Scholar 

  21. Bando K, Turrentine MW, Sharp TG, et al. Pulmonary hypertension after operations for congenital heart disease: analysis of risk factors and management. J Thorac Cardiovasc Surg 1996; 112(6): 1600–7; discussion 1607-9

    Article  PubMed  CAS  Google Scholar 

  22. Kumar A, Taylor GP, Sandor GG, et al. Pulmonary vascular disease in neonates with transposition of the great arteries and intact ventricular septum. Br Heart J 1993; 69(5): 442–5

    Article  PubMed  CAS  Google Scholar 

  23. Anderson RH, Baker EJ, McCartney FJ, et al., editors. Paediatric cardiology. 2nd ed. London: Churchill Livingstone, 2002

    Google Scholar 

  24. Holcomb R, Tyson R, Ivy D, et al. Congenital pulmonary venous stenosis presenting as persistent pulmonary hypertension of the newborn. Pediatr Pulmonol 1999; 28: 301–6

    Article  PubMed  CAS  Google Scholar 

  25. Ricci M, Elliott M, Cohen GA, et al. Management of pulmonary venous obstruction after correction of TAPVC: risk factors for adverse outcome. Eur J Cardiothorac Surg 2003; 24(1): 28–36; discussion 36

    Article  PubMed  CAS  Google Scholar 

  26. Rabinovitch M, Haworth S, Castaneda AR, et al. Lung biopsy in congenital heart disease: a morphometric approach to pulmonary vascular disease. Circulation 1978; 58: 1107–22

    Article  PubMed  CAS  Google Scholar 

  27. Meyrick B, Reid L. Ultrastructural findings in lung biopsy material from children with congenital heart defects. Am J Pathol 1980; 101: 527–37

    PubMed  CAS  Google Scholar 

  28. Rabinovitch M, Bothwell T, Hayakawa B. Pulmonary artery endothelial abnormalities in patients with congenital heart defects and pulmonary hypertension: a correlation of light with scanning electron microscopy and transmission electron microscopy. Lab Invest 1986; 55: 632–53

    PubMed  CAS  Google Scholar 

  29. Taipale J, Lohi J. Human mast cell chymase and leukocyte elastase release latent transforming growth factor B1 from the extracellular matrix of cultured human epithelial and endothelial cells. J Biol Chem 1995; 270: 4689–96

    Article  PubMed  CAS  Google Scholar 

  30. Jones P, Cowan K, Rabinovitch M. Induction of tenascin and fibronectin are features associated with increased smooth muscle cell proliferation during the development of progressive pulmonary hypertension in children. Am J Pathol 1997; 150: 1349–60

    PubMed  CAS  Google Scholar 

  31. Thomson J, Machado R, Pauciulo M, et al. Sporadic primary pulmonary hypertension is associated with germline mutations of the gene encoding BMPR-2, a receptor member of the TGF-beta family. J Med Genet 2000; 37: 741–5

    Article  PubMed  CAS  Google Scholar 

  32. Derynck R, Zhang YE. Smad-dependent and Smad-independent pathways in TGF-family signalling. Nature 2003; 425: 577–84

    Article  PubMed  CAS  Google Scholar 

  33. Roberts KE, McElroy JJ, Wong WP, et al. BMPR2 mutations in pulmonary arterial hypertension with congenital heart disease. Eur Respir J 2004; 24(3): 371–4

    Article  PubMed  CAS  Google Scholar 

  34. Rosenzweig EB, Barst RJ. Idiopathic pulmonary arterial hypertension in children. Curr Opin Pediatr 2005; 17(3): 372–80

    Article  PubMed  Google Scholar 

  35. Manes A, Campana C. Pulmonary hypertension: classification and diagnostic algorithm. Ital Heart J 2005; 6(10): 834–9

    PubMed  Google Scholar 

  36. Hattle L. Noninvasive assessment and differentiation of left ventricular outflow obstruction with Doppler ultrasound. Circulation 1981; 64: 381–7

    Article  Google Scholar 

  37. Ebeid MR, Ferrer PL, Robinson B, et al. Doppler echocardiographic evaluation of pulmonary vascular resistance in children with congenital heart disease. J Am Soc Echocardiogr 1996; 9(6): 822–31

    Article  PubMed  CAS  Google Scholar 

  38. Bossone E, Bodini BD, Mazza A, et al. Pulmonary arterial hypertension: the key role of echocardiography. Chest 2005; 127: 1836–43

    Article  PubMed  Google Scholar 

  39. Lopez-Candales A, Dohi K, Rajagopalan N, et al. Right ventricular dyssynchrony in patients with pulmonary hypertension is associated with disease severity and functional class. Cardiovasc Ultrasound 2005; 3: 23–6

    Article  PubMed  Google Scholar 

  40. Maiya S, Hislop AA, Flynn Y, et al. Response to bosentan in children with pulmonary hypertension. Heart 2006; 92(5): 664–70

    Article  PubMed  CAS  Google Scholar 

  41. LaFarge CG, Miettinen OS. The estimation of oxygen consumption. Cardiovasc Res 1970; 4(1): 23–30

    Article  PubMed  CAS  Google Scholar 

  42. Atz AM, Adatia I, Lock JE, et al. Combined effects of nitric oxide during acute pulmonary vasodilator testing. J Am Coll Cardiol 1999; 33: 813–9

    Article  PubMed  CAS  Google Scholar 

  43. Mikhail G, Gibbs J, Richardson M, et al. An evaluation of nebulized prostacycin in patients with primary and secondary pulmonary hypertension. Eur Heart J 1997; 18:1499–504

    Article  PubMed  CAS  Google Scholar 

  44. Holcomb SS. Understanding pulmonary arterial hypertension. Nursing 2004; 34(9): 50–4

    PubMed  Google Scholar 

  45. Sigurdsson G, Troughton RW, Xu XF, et al. Detection of pulmonary vein stenosis by transesophageal echocardiography: comparison with multidetector computed tomography. Am Heart J 2007; 153(5): 800–6

    Article  PubMed  Google Scholar 

  46. Monagle P, Adams M, Mahoney M, et al. Outcome of pediatric thromboembolic disease: a report from the Canadian Childhood Thrombophilia Registry. Pediatr Res 2000; 47: 763–6

    Article  PubMed  CAS  Google Scholar 

  47. Muthurangu V, Taylor A, Tulloh R, et al. Novel method of quantifying pulmonary vascular resistance by use of simultaneous invasive pressure monitoring and phase-contrast magnetic resonance flow. Circulation 2004; 110(7): 826–34

    Article  PubMed  Google Scholar 

  48. Muthurangu V, Atkinson D, Sermesant M, et al. Measurement of total pulmonary arterial compliance using invasive pressure monitoring and MR flow quantification during MR-guided cardiac catheterization. Am J Physiol Heart Circ Physiol 2005; 289(3): H1301–6

    Article  PubMed  CAS  Google Scholar 

  49. Tulloh R, Hislop A, Boels P, et al. Chronic hypoxia inhibits postnatal maturation of porcine intrapulmonary artery relaxation. Am J Physiol 1997; 272: H2436–45

    PubMed  CAS  Google Scholar 

  50. Black SM, Bekker JM, McMullan DM, et al. Alterations in nitric oxide production in 8-week-old lambs with increased pulmonary blood flow. Pediatr Res 2002; 52(2): 233–44

    Article  PubMed  CAS  Google Scholar 

  51. Adatia I, Haworth S. Circulating endothelin levels in children with congenital heart disease. Br Heart J 1993; 69: 233–6

    Article  PubMed  CAS  Google Scholar 

  52. Blyth KG, Groenning BA, Mark PB, et al. NT-proBNP can be used to detect RV systolic dysfunction in pulmonary hypertension. Eur Respir J 2007; 29(4): 737–44

    Article  PubMed  CAS  Google Scholar 

  53. Yuan JX, Rubin LJ. Pathogenesis of pulmonary arterial hypertension: the need for multiple hits. Circulation 2005; 111(5): 534–8

    Article  PubMed  Google Scholar 

  54. Lindberg L, Olsson AK, Jogi P, et al. How common is severe pulmonary hypertension after pediatric cardiac surgery? J Thorac Cardiovasc Surg 2002; 123(6): 1155–63

    Article  PubMed  CAS  Google Scholar 

  55. Ohsumi H, Sakamoto M, Yamazaki T, et al. Effects of fentanyl on carotid sinus baroreflex control of circulation in rabbits. Am J Physiol 1989; 256: R625–31

    PubMed  CAS  Google Scholar 

  56. Levy M, Tulloh RMH, Komai H, et al. Maturation of the contractile response and its endothelial modulation in newborn porcine intrapulmonary arteries. Pediatr Res 1995; 38: 25–9

    Article  PubMed  CAS  Google Scholar 

  57. Adatia I, Wessel DL. Therapeutic use of inhaled nitric oxide. Curr Opin Pediatr 1994; 6(5): 583–90

    Article  PubMed  CAS  Google Scholar 

  58. Abman SH. Neonatal pulmonary hypertension: a physiologic approach to treatment. Pediatr Pulmonol 2004; 26 Suppl.: 127–8

    Article  Google Scholar 

  59. Hermon M, Golej J, Burda G, et al. Intravenous prostacyclin mitigates inhaled nitric oxide rebound effect: a case control study. Artif Organs 1999; 23: 975–8

    Article  PubMed  CAS  Google Scholar 

  60. Kinsella JP, Abman SH. Inhaled nitric oxide therapy in children. Paediatr Respir Rev 2005; 6(3): 190–8

    Article  PubMed  Google Scholar 

  61. Ishikura K, Yamada N, Ito M, et al. Beneficial acute effects of rho-kinase inhibitor in patients with pulmonary arterial hypertension. Circ J 2006; 70(2): 174–8

    Article  PubMed  CAS  Google Scholar 

  62. Badesch DB, McLaughlin VV, Delcroix M, et al. Prostanoid therapy for pulmonary arterial hypertension. J Am Coll Cardiol 2004; 43(12 Suppl. S): 56S–61S

    Article  PubMed  CAS  Google Scholar 

  63. Clark RH, Huckaby JL, Kueser TJ, et al. Low-dose nitric oxide therapy for persistent pulmonary hypertension: 1-year follow-up. J Perinatol 2003; 23(4): 300–3

    Article  PubMed  CAS  Google Scholar 

  64. Adatia I, Perry S, Landzberg M, et al. Inhaled nitric oxide and hemodynamic evaluation of patients with pulmonary hypertension before transplantation. J Am Coll Cardiol 1995; 25(7): 1656–64

    Article  PubMed  CAS  Google Scholar 

  65. Wimmer M, Schlemmer M. Long-term hemodynamic effects of nifedipine on congenital heart disease with Eisenmenger’s mechanism in children. Cardiovasc Drugs Ther 1992; 6(2): 183–6

    Article  PubMed  CAS  Google Scholar 

  66. McMahon CJ, Kadkin J, Nihill MR. Rapid regression of primary pulmonary hypertension. Heart 2001; 86(1): E1

    Article  PubMed  CAS  Google Scholar 

  67. Humpl T, Reyes JT, Holtby H, et al. Beneficial effect of oral sildenafil therapy on childhood pulmonary arterial hypertension: twelve-month clinical trial of a single-drug, open-label, pilot study. Circulation 2005; 111(24): 3274–80

    Article  PubMed  CAS  Google Scholar 

  68. Weimann J, Ullrich R, Hromi J, et al. Sildenafil is a pulmonary vasodilator in awake lambs with acute pulmonary hypertension. Anesthesiology 2000; 92: 1702–12

    Article  PubMed  CAS  Google Scholar 

  69. Atz AM, Lefler AK, Fairbrother DL, et al. Sildenafil augments the effect of inhaled nitric oxide for postoperative pulmonary hypertensive crises. J Thorac Cardiovasc Surg 2002; 124(3): 628–9

    Article  PubMed  Google Scholar 

  70. Bharani A, Mathew V, Sahu A, et al. The efficacy and tolerability of sildenafil in patients with moderate-to-severe pulmonary hypertension. Indian Heart J 2003; 55(1): 55–9

    PubMed  Google Scholar 

  71. Brun H, Holmstrom H, Thaulow E. Sudden death during a change in treatment for pulmonary hypertension. Cardiol Young 2005; 15(2): 223–5

    Article  PubMed  Google Scholar 

  72. Della Torre F, Della Torre E, Di Berardino F. Sildenafil in pulmonary hypertension. Sarcoidosis Vasc Diffuse Lung Dis 2005; 22(1): 78–9

    PubMed  Google Scholar 

  73. Matot I, Gozal Y. Pulmonary responses to selective phosphodiesterase-5 and phosphodiesterase-3 inhibitors. Chest 2004; 125(2): 644–51

    Article  PubMed  CAS  Google Scholar 

  74. Cacoub P, Dorent R, Nataf P, et al. Endothelin-1 in pulmonary hypertension. N Engl J Med 1993; 329(26): 1967–8

    Article  PubMed  CAS  Google Scholar 

  75. Rosenzweig EB, Ivy DD, Dingemanse J, et al. Effects of long-term bosentan in children with pulmonary arterial hypertension. J Am Coll Cardiol 2005; 46(4): 697–704

    Article  PubMed  CAS  Google Scholar 

  76. Barst RJ, Ivy D, Dingemanse J, et al. Pharmacokinetics, safety efficacy of bosentan in pediatric patients with pulmonary arterial hypertension. Clin Pharmacol Ther 2003; 73(4): 372–82

    Article  PubMed  CAS  Google Scholar 

  77. Gatzoulis MA, Rogers P, Li W, et al. Safety and tolerability of bosentan in adults with Eisenmenger physiology. Int J Cardiol 2005; 98(1): 147–51

    Article  PubMed  Google Scholar 

  78. Apostolopoulou SC, Rammos S. Sitaxsentan in pulmonary arterial hypertension. Chest 2003; 123(5): 1772; author reply 1772–3

    Article  PubMed  Google Scholar 

  79. Barst RJ, Langleben D, Frost A, et al. Sitaxsentan therapy for pulmonary arterial hypertension. Am J Respir Crit Care Med 2004; 169(4): 441–7

    Article  PubMed  Google Scholar 

  80. Barst RJ, Rich S, Widlitz A, et al. Clinical efficacy of sitaxsentan, an endothelin-A receptor antagonist, in patients with pulmonary arterial hypertension: open-label pilot study. Chest 2002; 121(6): 1860–8

    Article  PubMed  CAS  Google Scholar 

  81. Prostacyclin: basic principles and clinical application in congestive heart failure and primary pulmonary hypertension. Proceedings of a symposium in Bologna, Italy, November 20, 1993. Am J Cardiol 1995; 75(3): 1A–73A

    Google Scholar 

  82. Barst RJ, Rubin LJ, Long WA, et al. A comparison of continuous intravenous epoprostenol (prostacyclin) with conventional therapy for primary pulmonary hypertension: the Primary Pulmonary Hypertension Study Group. N Engl J Med 1996; 334(5): 296–302

    Article  PubMed  CAS  Google Scholar 

  83. Simonneau G, Barst RJ, Galie N, et al. Continuous subcutaneous infusion of treprostinil, a prostacyclin analogue, in patients with pulmonary arterial hypertension: a double-blind, randomized, placebo-controlled trial. Am J Respir Crit Care Med 2002; 165(6): 800–4

    PubMed  Google Scholar 

  84. Vizza CD, Sciomer S, Morelli S, et al. Long term treatment of pulmonary arterial hypertension with beraprost, an oral prostacyclin analogue. Heart 2001; 86(6): 661–5

    Article  PubMed  CAS  Google Scholar 

  85. Barst RJ, McGoon M, McLaughlin V, et al. Beraprost therapy for pulmonary arterial hypertension. J Am Coll Cardiol 2003; 41(12): 2119–25

    Article  PubMed  CAS  Google Scholar 

  86. Baker SE, Hockman RH. Inhaled iloprost in pulmonary arterial hypertension. Ann Pharmacother 2005; 39(7–8): 1265–74

    Article  PubMed  CAS  Google Scholar 

  87. Hoeper MM, Faulenbach C, Golpon H, et al. Combination therapy with bosentan and sildenafil in idiopathic pulmonary arterial hypertension. Eur Respir J 2004; 24: 1007–10

    Article  PubMed  CAS  Google Scholar 

  88. Mogollon MV, Lage E, Cabezon S, et al. Combination therapy with sildenafil and bosentan reverts severe pulmonary hypertension and allows heart transplantation [case report]. Transplant Proc 2006; 38(8): 2522–3

    Article  PubMed  CAS  Google Scholar 

  89. Driscoll JA, Chakinala MM. Medical therapy for pulmonary arterial hypertension. Expert Opin Pharmacother 2008; 9(1): 65–81

    Article  PubMed  CAS  Google Scholar 

  90. Arima M, Kanoh T, Takagi A, et al. Clinical features of acute pulmonary thromboembolism in younger patients. Circ J 2003; 67(4): 330–3

    Article  PubMed  Google Scholar 

  91. Tanaka E, Harigai M, Tanaka M, et al. Pulmonary hypertension in systemic lupus erythematosus: evaluation of clinical characteristics and response to immunosuppressive treatment. J Rheumatol 2002; 29(2): 282–7

    PubMed  Google Scholar 

  92. Cheever KH. An overview of pulmonary arterial hypertension: risks, pathogenesis, clinical manifestations management. J Cardiovasc Nurs 2005; 20(2): 108–16; quiz 117–8

    PubMed  Google Scholar 

  93. National pulmonary hypertension centres of the UK and Ireland: consensus statement on the management of pulmonary hypertension in the UK and Ireland. Heart 2008; 94: 1–41

    Article  Google Scholar 

  94. Rich S, Kaufmann E, Levy PS. The effect of high doses of calcium-channel blockers on survival in primary pulmonary hypertension. N Engl J Med 1992; 327(2): 76–81

    Article  PubMed  CAS  Google Scholar 

  95. Higenbottam T. Intravenous epoprostenol for primary pulmonary hypertension [letter]. N Engl J Med 1996; 334(22): 1477; author reply 1477–8

    Article  PubMed  CAS  Google Scholar 

  96. Sandoval J, Aguirre JS, Pulido T, et al. Nocturnal oxygen therapy in patients with the Eisenmenger syndrome. Am J Respir Crit Care Med 2001; 164(9): 1682–7

    PubMed  CAS  Google Scholar 

  97. Kerstein D, Levy PS, Hsu DT, et al. Blade balloon atrial septostomy in patients with severe primary pulmonary hypertension. Circulation 1995; 91(7): 2028–35

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

No sources of funding were used to assist in the preparation of this review. Dr Tulloh has received lecture fees and honoraria from Actelion and Encysive.

Author information

Authors and Affiliations

  1. Department of Congenital Heart Disease, Bristol Royal Hospital for Children and Bristol Royal Infirmary, Upper Maudlin Street, Bristol, BS2 8BJ, UK

    Robert Tulloh (Consultant Paediatric Cardiologist)

Authors
  1. Robert Tulloh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robert Tulloh.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tulloh, R. Etiology, Diagnosis, and Pharmacologic Treatment of Pediatric Pulmonary Hypertension. Pediatr-Drugs 11, 115–128 (2009). https://doi.org/10.2165/00148581-200911020-00003

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00148581-200911020-00003

Keywords

Search

Navigation