title: Successful weaning from cardiopulmonary bypass with central venous prostaglandin E1 and left atrial norepinephrine infusion in patients with acute pulmonary hypertension.
abstract: OBJECTIVE
  Postoperative pulmonary hypertension increases the mortality risk in cardiac surgery. We have used central venous prostaglandin E1 (PGE1) and left atrial norepinephrine (NE) infusion to wean from cardiopulmonary bypass (CPB) patients with refractory postoperative pulmonary hypertension.
  
  
  METHODS
  Observational, nonrandomized study.
  
  
  METHODS
  Department of Cardiac Surgery in a university hospital.
  
  
  METHODS
  We studied 10 nonconsecutive American Society of Anesthesiologists III and New York Heart Association class III-IV patients with postoperative pulmonary hypertension and low cardiac output syndrome preventing separation from CPB.
  
  
  METHODS
  Patients received right atrial PGE1 (31.5 +/- 6.26 ng/kg/min) and left atrial NE (0.11 +/- 0.02 microg/kg/min) infusion. Hemodynamic data were obtained before CPB (T0), after CPB under maximal inotropes and vasodilator infusion (T1), 10 mins (T2) and 12 hrs (T3) after PGE1 and NE infusion, and 48 hrs after withdrawal of PGE1 and NE (T4).
  
  
  RESULTS
  All patients were successfully weaned from CPB and survived. The biatrial infusion of PGE1 and NE caused a dramatic reduction in mean pulmonary artery pressure (from 42.8 +/- 5.1 mm Hg at T1 to 28.5 +/- 2.6 mm Hg at T2 and 20.5 +/- 2.0 mm Hg at T4), pulmonary vascular resistance index (from 1158 +/- 269 dyne x sec/cm5 x m2 at T1 to 501 +/- 99 dyne x sec/cm5 x m2 at T2 and 246 +/- 50 dyne x sec/cm5 x m2 at T4), and pulmonary-to-systemic vascular resistance index ratio (from 0.61 +/- 0.17 at T1 to 0.20 +/- 0.04 at T2 and 0.11 +/- 0.03 at T4). Cardiac index increased from 1.7 +/- 0.2 L/min/m2 at T1 to 2.3 +/- 0.2 L/min/m2 at T2 and 2.9 +/- 0.1 L/min/m2 at T4.
  
  
  CONCLUSIONS
  In patients with refractory postoperative pulmonary hypertension, the combined administration of low-dose PGE1 in the right atrium and NE in the left atrium is an effective means to wean patients from cardiopulmonary bypass.
authors.affiliation: Department of Anesthesia and Intensive Care, University of Rome La Sapienza, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Tritapepe
authors.forename: P
authors.initials: P
authors.lastname: Voci
authors.forename: A A
authors.initials: AA
authors.lastname: Cogliati
authors.forename: E
authors.initials: E
authors.lastname: Pasotti
authors.forename: U
authors.initials: U
authors.lastname: Papalia
authors.forename: A
authors.initials: A
authors.lastname: Menichetti
mesh_terms: D000208:Acute Disease; D000328:Adult; D000527:Alprostadil / Q000008:administration & dosage*; D006328:Cardiac Catheterization; D002303:Cardiac Output, Low / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D002405:Catheterization, Central Venous; D004359:Drug Therapy, Combination; D005260:Female; D006325:Heart Atria; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000008:administration & dosage*; D011669:Pulmonary Wedge Pressure / Q000187:drug effects; D016896:Treatment Outcome; D014655:Vascular Resistance / Q000187:drug effects; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*; D014665:Vasodilator Agents / Q000008:administration & dosage*
chemical_list: D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents; D000527:Alprostadil; D009638:Norepinephrine