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

3/10/2017 Great Ormond Street Hospital UCL UCL PRO/CON Debate: Aggressive versus progressive therapeutic approach Dr. Shahin Moledina - Director UK National Paediatric PH Program UCL Centre for Cardiovascular Imaging UCL UCL Past battles Get the big guns out The enemy Aggressive Surround them Wait for reinforcements UCL Centre for Cardiovascular Imaging UCL Centre for Cardiovascular Imaging 1

3/10/2017 Enemy is aggressive UCL UCL UCL Centre for Cardiovascular Imaging UCL Centre for Cardiovascular Imaging Moves quickly Spares no-one UCL UCL Rapid proliferation Don’t catch-up Falcetti AJRCCM 2010 UCL Centre for Cardiovascular Imaging UCL Centre for Cardiovascular Imaging 2

3/10/2017 Treating consequences Past Battles UCL UCL Barst Circulation 2012 UCL Centre for Cardiovascular Imaging UCL Centre for Cardiovascular Imaging The Arsenal The Big Guns UCL UCL Versus Jain et al Chest 2017 Jain et al Chest 2017 UCL Centre for Cardiovascular Imaging UCL Centre for Cardiovascular Imaging 3

3/10/2017 The Big Guns Big guns UCL UCL Barst. Circulation 1999, Yung Circulation 2004 Jain et al Chest 2017 UCL Centre for Cardiovascular Imaging UCL Centre for Cardiovascular Imaging Surround them UCL UCL Jain et al Chest 2017 UCL Centre for Cardiovascular Imaging UCL Centre for Cardiovascular Imaging 4

3/10/2017 Pincer Manœuvre Cut off supply lines UCL UCL Increased Resistance Vascular Damage Reduced Compliance Mechanical Stress Tan Plos One 2014; Hisplop A unpublished; Tedford Circ 2012 UCL Centre for Cardiovascular Imaging UCL Centre for Cardiovascular Imaging Hold out for reinforcements Anyway - Who are you calling aggressive? UCL UCL Needle and wire Snare in LPA through Ao Non-Industry Industry Funded Funded Trials Trials Snare wire Covered stent J Heart Lung Transplant 2013;32:381–387 Esch, Lock et al UCL Centre for Cardiovascular Imaging UCL Centre for Cardiovascular Imaging 5

3/10/2017 UCL Current strategies We have some big limited guns Aggressive PH is aggressive The cavalry is coming Cry havoc and let slip the Dogs of War UCL Centre for Cardiovascular Imaging 6