Massive pulmonary edema and death after prostacyclin infusion in a patient with pulmonary veno-occlusive disease.
Pulmonary veno-occlusive disease (PVOD) is a rare form of pulmonary hypertension associated with fibrotic occlusion of the smaller pulmonary veins. Although vasodilator therapy is effective in many patients with primary pulmonary hypertension, the role of vasodilators in PVOD is unclear because of concerns about precipitating pulmonary edema. Recently, however, there have been reports of successful therapy with oral vasodilators or intravenous administration of prostacyclin in patients with PVOD. In contrast, a patient with PVOD is described who developed acute pulmonary edema and respiratory failure during low-dose prostacyclin infusion, leading to death. This report suggests that vasodilators, especially prostacyclin, must be used with extreme caution in patients with known PVOD.
Palmer
S M
SM
Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
Robinson
L J
LJ
Wang
A
A
Gossage
J R
JR
Bashore
T
T
Tapson
V F
VF
D000328:Adult; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D011464:Epoprostenol / Q000008:administration & dosage / Q000009:adverse effects*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D011654:Pulmonary Edema / Q000139:chemically induced*; D011668:Pulmonary Veno-Occlusive Disease / Q000150:complications / Q000188:drug therapy*; D011669:Pulmonary Wedge Pressure; D013902:Radiography, Thoracic; D012131:Respiratory Insufficiency / Q000209:etiology
D000959:Antihypertensive Agents; D011464:Epoprostenol