The use of inhaled prostacyclin in nitroprusside-resistant pulmonary artery hypertension.
Because nitroprusside NTP infusion used to differentiate between fixed and reversible pulmonary artery hypertension in heart transplant candidates can result in systemic hypotension before reducing pulmonary artery pressures, we observed the effect or inhaled prostacyclin (PGI(2)) on pulmonary artery pressures and transpulmonic gradient (TPG) in patients with NTP-resistant pulmonary artery hypertension. Six patients undergoing evaluation for orthotropic heart transplant (OHTX) with NTP-resistant pulmonary artery hypertension received inhaled PGI(2), with hemodynamic measurements made at baseline, on NTP- and PGI(2) inhaled after returning to baseline. Compared with hemodynamic results with NTP, inhaled PGI(2) caused significant decrease in pulmonary artery systotic pressure, 43.8 +/- 4.8 mm Hg vs 63.2 +/- 2.04 mm Hg (p < 0.001); Mean pulmonary artery pressure, 22.7 +/- 4.18 vs 32.3 +/- 3.39 mm Hg (p < 0.05); and TPG, 11.5 +/- 3.73 vs 17.0 +/- 4.69 mm Hg (p < 0.05), with a 40% decrease in pulmonary vascular resistance/systemic vascular resistance ratio. We conclude that inhaled PGI(2) has benefit in reversing pulmonary artery hypertension resistant to NTP, in patients undergoing OHTX evaluation which is due to its more selective pulmonary vasodilation.
Weston
M W
MW
LifeLink Transplant Institute, Tampa, Florida 33606, USA.
Isaac
B F
BF
Crain
C
C
D000280:Administration, Inhalation; D000328:Adult; D004351:Drug Resistance; D011464:Epoprostenol / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D016027:Heart Transplantation; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009599:Nitroprusside / Q000008:administration & dosage* / Q000009:adverse effects; D011300:Preoperative Care; D011669:Pulmonary Wedge Pressure / Q000187:drug effects; D014655:Vascular Resistance / Q000187:drug effects
D009599:Nitroprusside; D011464:Epoprostenol