title: Inhaled prostacyclin for the treatment of pulmonary hypertension after cardiac surgery.
abstract: OBJECTIVE
  To describe the effects of inhaled prostacyclin administered after cardiopulmonary bypass (CPB) to a patient with severe pulmonary hypertension.
  
  
  METHODS
  Case report and literature review.
  
  
  METHODS
  Cardiac surgical operating rooms and postoperative recovery unit.
  
  
  METHODS
  A 63-yr-old female who had undergone mitral and aortic valve replacement for rheumatic heart disease.
  
  
  METHODS
  Administration of inhaled prostacyclin to decrease pulmonary artery pressures and to permit discontinuation of CPB.
  
  
  RESULTS
  The patient was unable to be removed from CPB because of severe pulmonary hypertension precipitating acute right heart failure, despite administration of milrinone, norepinephrine, and nitroglycerin infusions. Inhaled prostacyclin was started at a dosage of 50 ng/kg/min, and the patient was able to be weaned from CPB. The inhaled prostacyclin was continued for 4 days postoperatively, with no signs of tolerance or systemic effects.
  
  
  CONCLUSIONS
  Inhaled prostacyclin is an effective and selective pulmonary vasodilator at the dosage given in this report. Prolonged use is not associated with tolerance or systemic effects. The apparatus required for the delivery of inhaled prostacyclin is simple, inexpensive, and readily available in most hospitals. A review of the literature suggests that inhaled prostacyclin is effective in a number of clinical settings and displays comparable efficacy and hemodynamic effects to inhaled nitric oxide.
authors.affiliation: Department of Anesthesiology, University of Virginia Health Sciences Center, Charlottesville, VA 22908, USA.
authors.forename: Stuart M
authors.initials: SM
authors.lastname: Lowson
authors.forename: Allan
authors.initials: A
authors.lastname: Doctor
authors.forename: Brian K
authors.initials: BK
authors.lastname: Walsh
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Doorley
mesh_terms: D000280:Administration, Inhalation; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002315:Cardiopulmonary Bypass; D011464:Epoprostenol / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000209:etiology; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy* / Q000209:etiology
chemical_list: D000959:Antihypertensive Agents; D011464:Epoprostenol