Pulmonary Hypertension
The diagnosis and therapy of pulmonary hypertension has dramatically changed these last years both in the understanding of the physiopathology and in the treatment. Our currents works is dedicated to the creation of registries to have a better knowledge of the etiology and epidemiology of pediatric pulmonary hypertension. We are also working on the assessments of the new therapies in the pediatric patients as well as to develop specific formulation for this population. Several studies are also focused on pulmonary hypertension associated with congenital heart disease both in animals and humans. These studies are planned in association with different centers in UCSF California (Prof Fineman), Great ormond street London ( prof Schulze Neick) and Paris ( Prof Humbert)
Childhood obesity poses a major public health problem and there is increasing evidence that foundation of cardiovascular diseases and metabolic syndrome lays early in life. In a recent study, we demonstrated that obese pre-pubertal children have altered endothelial and smooth muscle function of the brachial artery, low cardiorespiratory fitness, reduced physical activity, low HDL-cholesterol, as well as augmented arterial stiffness of the carotid artery, systemic blood pressure, abdominal fat and fasting insulin. In a randomized controlled trial (RCT), we showed that a 3-month exercise training program at moderate intensity significantly reduced systemic blood pressure, whole body and abdominal fatness, and prevented intima-media thickning of the carotid artery. The cardiorespiratory fitness, physical activity and quality of life increased after exercise training. The intervention did not show any effects on endothelial and smooth muscle functions, that may be due to insufficient duration or intensity of training, as well as counteracting factors such as unhealthy diet or sedentary lifestyle in the family. We plan now to perform a RCT to evaluate the effects of a moderate 6-month exercise training program, compared to a combined family-based behavioral treatment plus exercise training on cardiovascular, metabolic and psychological co-morbidities. Results of this intervention will provide essential information to support the development of the therapy of childhood obesity in Switzerland.