International Journal of Cardiovascular ResearchISSN: 2324-8602

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Research Article, Int J Cardiovasc Res Vol: 4 Issue: 2

Oral Propranolol: A Corner Stone in the Therapeutic Strategy of Infantile Haemangiomas

Hany M Abo-Haded1, Ahmed A Khalil2 and Abeer Fathy3*
1Pediatric Cardiology Unit, Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt
2Department of plastic surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
3Gasrtoenterology and Hepatology Unit, Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Corresponding author : Abeer Fathy, MD MHS
Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, 35516, Egypt
Tel: + 002 01020579852
E-mail: [email protected]
Received: February 15, 2015 Accepted: February 27, 2015 Published: March 02, 2015
Citation: Fathy A, Haded HMA, Khalil AA (2015) Oral Propranolol: A Corner Stone in the Therapeutic Strategy of Infantile Haemangiomas. Int J Cardiovasc Res 4:2. doi:10.4172/2324-8602.1000202

Abstract

 Oral Propranolol: A Corner Stone in the Therapeutic Strategy of Infantile Haemangiomas

Infantile hemangiomas are the most common tumors of childhood. Despite their benign and self-limited nature, some hemangiomas can cause complications such as ulceration or life-altering disfigurement. In addition, they may compromise vital organ function, or herald underlying developmental anomalies of the central nervous system or spine [1]. Until recently, high-dose steroid therapy was the mainstay treatment for problematic proliferating infantile hemangioma [2]. Whilst corticosteroids are effective, they are associated with significant adverse effects as cushing syndrome, growth retardation, hirsutism, hypertension, and immunosuppression [3]. Interferon alpha is a potent inhibitor of angiogenesis that can be used in the treatment of infantile hemangiomas [4]. However, its reported severe neurotoxicity, including spastic diplegia, limits its use to cases with life-threatening hemangiomas that have not responded to other forms of treatment [5]. Vincristine was initially used in the treatment of the Kasabach-Merritt phenomenon [6]. Moreover,it is used as an alternative therapy for glucocorticoid-unresponsive, lifethreatening, or severely life-altering hemangiomas[7]. Pulsed dye laser therapyis another treatment option that was found to be beneficial for select infantile hemangiomas including those with small superficial, ulcerated, or involuting lesions [8,9]. In 2008, a French group accidently observed accelerated involution of large facial hemangiomas in two infants following treatment with propranolol for heart failure [10]. These favorable results led to the initiation of some case reports and observational studies to evaluate the efficacy of propranolol in the treatment of proliferating infantile hemangioma [11-14]. To date, the mechanism of action of propranolol on infantile hemangioma is not clear [15]. Moreover, there are some concerns about the potential complications with propranolol usage. The most frequently reported serious side effects were asymptomatic hypotension, asymptomatic bradycardia[16], pulmonary symptoms related to blockade of adrenergic bronchodilation [17], hypoglycemia [17], and hyperkalemia [18]. The most commonly reported non potentially life-threatening side effects were sleep disturbances including nightmares, somnolence, cool or mottled extremities, diarrhea, and gastroesophageal reflux/upset [19]. .

Keywords: Corner stone; Infantile hemangiomas; Oral propranolol; Therapeutic strategy

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