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Original Research: Pulmonary Vascular Disease |

Pulmonary Venoocclusive Disease in ChildhoodPulmonary Venoocclusive Disease in Children

Cornelia Woerner, MD; Ernest Cutz, MD; Shi-Joon Yoo, MD, PhD; Hartmut Grasemann, MD; Tilman Humpl, MD, PhD
Author and Funding Information

From the Department of Pediatrics, Division of Cardiology (Drs Woerner, Yoo, and Humpl), Department of Laboratory Medicine and Pathobiology (Dr Cutz), Department of Pediatrics, Division of Respiratory Medicine (Dr Grasemann), Department of Critical Care Medicine (Dr Humpl), and Department of Medical Imaging (Dr Yoo), University of Toronto, Hospital for Sick Children, Toronto, ON, Canada.

CORRESPONDENCE TO: Tilman Humpl, MD, PhD, The Hospital for Sick Children, Critical Care and Cardiology, 555 University Ave, Toronto, ON, M5G 1X8, Canada; e-mail: tilman.humpl@sickkids.ca


FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(1):167-174. doi:10.1378/chest.13-0172
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BACKGROUND:  Pulmonary venoocclusive disease (PVOD) is a rare lung disease, diagnosed in 5% to 10% of patients with pulmonary hypertension (PH). The incidence, prevalence, and etiology of PVOD in children are not well defined. The mortality remains high, related, at least partly, to the limited treatment options.

METHODS:  This retrospective analysis (1985-2011) summarizes symptoms, associated factors, treatment, and outcomes of nine pediatric patients (five girls, four boys) with histologic confirmation of PVOD.

RESULTS:  PH was diagnosed at a mean age of 13.5 years (range, 8-16 years), followed by the definitive diagnosis of PVOD at a mean age of 14.3 years (range, 10-16 years). Symptoms such as decreased exercise tolerance (n = 6) and/or shortness of breath (n = 9) preceded the diagnosis by 21 months on average; the mean survival time after diagnosis was 14 months (range, 0-47 months). CT scans of the lungs showed typical radiologic features. Treatment included supplemental home oxygen (n = 5), diuretics (n = 9), warfarin (n = 4), and pulmonary vasodilators (n = 4). Four children were listed for lung transplantation, and three have undergone transplantation. Eight patients died, including two after lung transplantation. One patient with lung transplant survived with good quality of life.

CONCLUSIONS:  PVOD is an important differential diagnosis for pediatric patients with PH. CT scanning is a valuable tool to image lung abnormalities; the definitive diagnosis can only be made by examination of lung biopsy specimens, which subjects the patient to additional risk. Early listing for lung transplantation is essential, as the mean survival time is only 14 months.

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