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Medline ® Abstract for Reference 40

of 'High altitude disease: Unique pediatric considerations'

Pulmonary artery pressure and cardiac function in children and adolescents after rapid ascent to 3,450 m.
Allemann Y, Stuber T, de Marchi SF, Rexhaj E, Sartori C, Scherrer U, Rimoldi SF
Am J Physiol Heart Circ Physiol. 2012;302(12):H2646. Epub 2012 Apr 20.
High-altitude destinations are visited by increasing numbers of children and adolescents. High-altitude hypoxia triggers pulmonary hypertension that in turn may have adverse effects on cardiac function and may induce life-threatening high-altitude pulmonary edema (HAPE), but there are limited data in this young population. We, therefore, assessed in 118 nonacclimatized healthy children and adolescents (mean±SD; age: 11±2 yr) the effects of rapid ascent to high altitude on pulmonary artery pressure and right and left ventricular function by echocardiography. Pulmonary artery pressure was estimated by measuring the systolic right ventricular to right atrial pressure gradient. The echocardiography was performed at low altitude and 40 h after rapid ascent to 3,450 m. Pulmonary artery pressure was more than twofold higher at high than at low altitude (35±11 vs. 16±3 mmHg; P<0.0001), and there existed a wide variability of pulmonary artery pressure at high altitude with an estimated upper 95% limit of 52 mmHg. Moreover, pulmonary artery pressure and its altitude-induced increase were inversely related to age, resulting in an almost twofold larger increase in the 6- to 9- than in the 14- to 16-yr-old participants (24±12 vs. 13±8 mmHg; P = 0.004). Even in children with the most severe altitude-induced pulmonary hypertension, right ventricular systolic function did not decrease, but increased, and none of the children developed HAPE. HAPE appears to be a rare event in this young population after rapid ascent to this altitude at which major tourist destinations are located.
Department of Cardiology, Inselspital, University Hospital, Bern, Switzerland.