Abstract
In pediatric medicine, the use of phosphodiesterase inhibitors has evolved despite the paucity of research evaluating efficacy and the inherent flaw of attempting to extrapolate adult data to the pediatric population. Phosphodiesterase 3 (PDE3) inhibitors, namely milrinone, have been used in the management of acute and chronic heart failure with the majority of studies evaluating infants and children in the postoperative setting. However, phosphodiesterase 5 (PDE5) inhibitors, namely sildenafil, have been used in patients with pulmonary hypertension as well as in those with single ventricle physiology for poor hemodynamics attributable to elevated pulmonary artery pressures status post cavopulmonary palliation. Over two decades of experience and research with PDE inhibition in pediatric heart failure leads to more questions than answers. In summary, via clinical studies, translational projects, and ongoing basic science research, the journey to optimal use of these medications is facilitated.
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