Pulmonary Hypertension Following Cardiac Surgery in Children with Down Syndrome: A Review

Pulmonary hypertension is a known complication in children with congenital heart lesions especially those with left-to-right shunts. Children with Down syndrome are known to have certain types of congenital heart lesions like atrioventricular septal defect, ventricular septal defect, patent ductus arteriosus etc. These lesions can cause pulmonary hypertension if left untreated in any child. In those with Down syndrome, pulmonary hypertension is said to be worse. Several factors have been identified. These factors are upper airway obstruction that is common in all children with this syndrome, abnormality in their pulmonary vascular bed, lower levels of nitric oxide production which is a known vasodilator, abnormalities in their immune system which predisposes them to respiratory tract infection, gastroesophageal reflux disease and recently pulmonary hemosiderosis has been reported. Therefore, children with Down syndrome being prepared for cardiac surgery should be thoroughly evaluated and if possible measures should be taken to minimize untoward effects of these factors