Inhaled prostacyclin for the treatment of pulmonary hypertension after cardiac surgery.
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.
Lowson
Stuart M
SM
Department of Anesthesiology, University of Virginia Health Sciences Center, Charlottesville, VA 22908, USA.
Doctor
Allan
A
Walsh
Brian K
BK
Doorley
Patricia A
PA
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
D000959:Antihypertensive Agents; D011464:Epoprostenol