UCL PRO/CON Debate: Aggressive versus progressive therapeutic - - PowerPoint PPT Presentation

3/10/2017 1 UCL

Great Ormond Street Hospital

PRO/CON Debate: Aggressive versus progressive therapeutic approach

• Dr. Shahin Moledina - Director UK National Paediatric PH Program

UCL Centre for Cardiovascular Imaging

UCL

UCL Centre for Cardiovascular Imaging

UCL

UCL Centre for Cardiovascular Imaging

UCL

The enemy Past battles Get the big guns out

Aggressive

Surround them Wait for reinforcements

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UCL Centre for Cardiovascular Imaging

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UCL Centre for Cardiovascular Imaging

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Enemy is aggressive

UCL Centre for Cardiovascular Imaging

UCL

Moves quickly

Falcetti AJRCCM 2010 Rapid proliferation Don’t catch-up

UCL Centre for Cardiovascular Imaging

UCL

Spares no-one

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UCL Centre for Cardiovascular Imaging

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Treating consequences

UCL Centre for Cardiovascular Imaging

UCL

Past Battles

Barst Circulation 2012

UCL Centre for Cardiovascular Imaging

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Jain et al Chest 2017

The Arsenal

UCL Centre for Cardiovascular Imaging

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Jain et al Chest 2017

The Big Guns

Versus

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UCL Centre for Cardiovascular Imaging

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Jain et al Chest 2017

The Big Guns

UCL Centre for Cardiovascular Imaging

UCL

• Barst. Circulation 1999, Yung Circulation 2004

Big guns

UCL Centre for Cardiovascular Imaging

UCL

Jain et al Chest 2017

Surround them

UCL Centre for Cardiovascular Imaging

UCL

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UCL Centre for Cardiovascular Imaging

UCL

Pincer Manœuvre

UCL Centre for Cardiovascular Imaging

UCL

Cut off supply lines

Increased Resistance Vascular Damage Mechanical Stress Reduced Compliance

Tan Plos One 2014; Hisplop A unpublished; Tedford Circ 2012

UCL Centre for Cardiovascular Imaging

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Industry Funded Trials Non-Industry Funded Trials

Hold out for reinforcements

UCL Centre for Cardiovascular Imaging

UCL

J Heart Lung Transplant 2013;32:381–387 Esch, Lock et al

Anyway - Who are you calling aggressive?

Snare in LPA Needle and wire through Ao Snare wire Covered stent

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UCL Centre for Cardiovascular Imaging

UCL

PH is aggressive Current strategies limited We have some big guns

Aggressive

The cavalry is coming Cry havoc and let slip the Dogs of War