Early postoperative treprostinil in for severe pulmonary arterial hypertension in a high-risk pediatric patient with complete atrioventricular septal defect: a case report

Figures

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  Fig. 1. Preoperative and 1-year follow-up transthoracic echocardiographic (TTE) findings. A Preoperative TTE showing abnormal intracardiac shunting across the common atrioventricular junction. B Preoperative TTE demonstrating a single atrium and common atrioventricular valve, and inlet ventricular septal defect. C TTE showing a residual atrial-level shunt across the retained fenestration. D TTE showing a peak velocity and an estimated transtricuspid pressure gradient

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  Fig. 2. Preoperative chest computed tomography and postoperative pulmonary artery computed tomography angiography findings. A Preoperative chest computed tomography revealing cardiomegaly and dilatation of the main pulmonary artery. B Preoperative chest computed tomography showing faint bilateral perivascular patchy pulmonary opacities. C Postoperative pulmonary artery computed tomography angiography showing persistent enlargement of the central pulmonary arteries. D Three-dimensional reconstruction of postoperative pulmonary artery computed tomography angiography demonstrating the overall morphology of the central pulmonary arteries

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  Fig. 3. Early postoperative mean pulmonary artery pressure, mean arterial pressure, and treprostinil dose trendsEarly postoperative changes in mean pulmonary artery pressure, mean arterial pressure, and intravenous treprostinil dose during the initial ICU period. Time zero was defined as ICU admission at 19:15 on the day of surgery. Data points were plotted according to the actual postoperative nursing-record time points rather than fixed hourly intervals. Treprostinil was initiated at 5 ng/kg/min and gradually titrated to 10 ng/kg/min at 2 hours, 15 ng/kg/min at 6 hours, and 20 ng/kg/min at 10 hours under close hemodynamic monitoring. During dose escalation, pulmonary and systemic hemodynamics were closely monitored, with mPAP showing an overall downward trend and MAP remaining acceptable