Recommendations from the Association for European Paediatric and Congenital Cardiology for training in pulmonary hypertension

Abstract

Pulmonary hypertension is a complex and progressive condition that is either idiopathic or heritable, or associated with one or multiple health conditions, with or without congenital or acquired cardiovascular disease. Recent developments have tremendously increased the armamentarium of diagnostic and therapeutic approaches in children and young adults with pulmonary hypertension that is still associated with a high morbidity and mortality. These modalities include non-invasive imaging, pharmacotherapy, interventional and surgical procedures, and supportive measures. The optimal, tailored diagnostic and therapeutic strategies for pulmonary hypertension in the young are rapidly evolving but still face enormous challenges: Healthcare providers need to take the patient’s age, development, disease state, and family concerns into account when initiating advanced diagnostics and treatment. Therefore, there is a need for guidance on core and advanced medical training in paediatric pulmonary hypertension. The Association for European Paediatric and Congenital Cardiology working group “pulmonary hypertension, heart failure and transplantation” has produced this document as an expert consensus statement; however, all recommendations must be considered and applied in the context of the local and national infrastructure and legal regulations.

Pulmonary hypertension in bronchopulmonary dysplasia

“…Due to this ambiguity, BPD patients at risk for or with confirmed PH must be evaluated and cared for by a multidisciplinary team of PH specialists, including neonatologists, pediatric cardiologists, and pulmonologists, with experience in the care of infants with PH. 12,18,19 CURRENT CONCEPTS OF THE PATHOBIOLOGY OF BPD-PH PH associated with BPD mainly develops in survivors of extreme preterm birth as a result of incomplete lung development (abnormal alveolarization), postnatal hyperoxia-/hypoxia-triggered vascular remodeling, and the rarefication of pulmonary blood vessels (vascular growth arrest). 2 Dysbalanced TGFβ/BMP 20 and VEGF signaling in BPD are pathobiological hallmarks of BPD-PH.…”

Association for European Paediatric and Congenital Cardiology recommendations for basic training in paediatric and congenital cardiology 2020

“…For further details, see also the recommendations of the respective Association for European Paediatric and Congenital Cardiology Working Groups. [1][2][3][4][5][6] Basic knowledge and skills Epidemiology, genetics, embryology, normal and abnormal anatomy of the cardiovascular system A basic understanding of these should be achieved during the first year by regular teaching sessions and by attending appropriate courses. Attendance at a course on anatomy in CHD shall be encouraged.…”

“…Those wishing to achieve more advanced training in particular areas of paediatric cardiology should consult the training recommendations of the different Association for European Paediatric and Congenital Cardiology Working Groups available on the Association for European Paediatric and Congenital Cardiology website (www.aepc.org) and the respective publications. [1][2][3][4][5][6][7] The development of training requirements is the responsibility of the Educational Committee and the Association for European Paediatric and Congenital Cardiology Council in collaboration with the Working Groups of the Association for European Paediatric and Congenital Cardiology.…”

“…Details on advanced training programmes are addressed in the respective Association for European Paediatric and Congenital Cardiology Working Group publications. [1][2][3][4][5][6][7]…”

Paediatric/congenital cardiology physician scientists—An endangered species

“…The transition to independence must be carefully planned because of the additional responsibilities inherent to clinical medicine, and the critical risk of attrition, particularly in this period. After the completion of clinical training, 10‐12 FIT/ECI might be hired as ‘instructors’ or assistant professors while continuing their research in a mentored environment 13 . Successfully obtaining transitional funding such as a K‐awards from the National Institutes of Health (NIH), or similar federal grants, is often an important step towards independence (Table 1).…”