[Aerosolized prostacyclin for preoperative evaluation and post-cardiosurgical treatment of patients with pulmonary hypertension].
BACKGROUND
Inhaled nitric oxide (NO) has been shown to selectively lower pulmonary vascular resistance and is applied in patients with pulmonary hypertension (PHT). However, application and monitoring is complex and not always successful ("non-responders"). We evaluated the effect of aerolized prostacyclin (aePGI2) as a therapeutic alternate to NO.


METHODS
aePGI2 and NO were applied to patients with different causes of pulmonary hypertension (Group 1a: preoperative patients with intracardiac shunting defects and Eisenmenger's disease, n = 30; Group 1b: patients with primary or postoperative PHT, n = 13; Group 2: PHT immediately following surgery for congenital heart disease, n = 6).


RESULTS
Pulmonary vascular resistance could be lowered significantly (Group 1a: from 91% of systemic vascular resistance to 58% with NO and 53% with aePGI2; Group 1b: from 20.2 Wood Units*m2 to 13.4 and 11.3; Group 2: from 24.9 Wood Units*m2 to 9.5 and 10.5); cardiac index increased (Group 1b: from 2.96 to 3.55 and 3.96 l/min*m2, Group 2: from 1.57 to 1.89 and 2.00 l/min*m2).


CONCLUSIONS
The short-term application of aePGI2 shows a selective pulmonary vasodilation similar to NO. Given adequate monitoring, aePGI2 appears to be useful for the acute treatment of PHT.
Schulze-Neick
I
I
Deutsches Herzzentrum Berlin, Abteilung für Angeborene Herzfehler, Augustenburger Platz 1, Berlin.
Uhlemann
F
F
Nürnberg
J H
JH
Bültmann
M
M
Haas
N A
NA
Dähnert
I
I
Alexi-Meshkishvili
V
V
Opitz
C
C
Pappert
D
D
Rossaint
R
R
Kleber
F X
FX
Hetzer
R
R
Lange
P E
PE
D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D000336:Aerosols; D006328:Cardiac Catheterization; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D004541:Eisenmenger Complex / Q000188:drug therapy; D011464:Epoprostenol / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery; D006343:Heart Septal Defects / Q000601:surgery; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000209:etiology; D007223:Infant; D008168:Lung / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000008:administration & dosage / Q000009:adverse effects; D011183:Postoperative Complications / Q000188:drug therapy* / Q000209:etiology; D011292:Premedication; D013318:Stroke Volume / Q000187:drug effects; D014655:Vascular Resistance / Q000187:drug effects; D014665:Vasodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects
D000336:Aerosols; D014665:Vasodilator Agents; D009569:Nitric Oxide; D011464:Epoprostenol