Acute pulmonary edema caused by epoprostenol infusion in a child with scimitar syndrome and pulmonary hypertension.
BACKGROUND
Intravenous epoprostenol is frequently administered in adults and children for treatment of pulmonary hypertension. Although generally safe, pulmonary edema has been described in a few case reports of adult patients with pulmonary veno-occlusive disease.


METHODS
We present an infant who had an operation for scimitar syndrome and abnormal drainage of the right pulmonary veins into the inferior vena cava who developed pulmonary edema while receiving a prostacyclin infusion. The typical partial anomalous pulmonary venous drainage was operatively corrected at 6 days of age, and an accompanying coarctation was resected. At 7 months of age, diagnostic cardiac catheterization was performed to evaluate suspected pulmonary hypertension. Pulmonary pressure was elevated to supra-systemic values, and obstructed venous drainage of the right hypoplastic lung was demonstrated. To decrease pulmonary hypertension during weaning and extubation, epoprostenol infusion was initiated. Sixty minutes after extubation, massive acute pulmonary edema lead to reintubation. Mean airway pressure of 16 mm Hg (21 mbar) with pure oxygen ventilation was initially required, with an oxygenation index of 14, a ventilation index of 36, and an alveolar-arterial oxygen tension difference of 541 mm Hg. After discontinuation of epoprostenol, weaning and extubation was successful.


CONCLUSIONS
Pulmonary edema caused by prostacyclin infusion in patients with impaired postcapillary pulmonary drainage may also be encountered in children and has to be anticipated.
von Schnakenburg
Christian
C
Department of Pediatric Cardiology and Pediatric Intensive Care Medicine, Georg-August-Universitaet Goettingen, Goettingen, Germany.
Peuster
Matthias
M
Norozi
Kambiz
K
Roebl
Markus
M
Maibohm
Michael
M
Wessel
Armin
A
Fink
Christoph
C
D000208:Acute Disease; D000959:Antihypertensive Agents / Q000009:adverse effects*; D011464:Epoprostenol / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000188:drug therapy*; D007231:Infant, Newborn; D011654:Pulmonary Edema / Q000139:chemically induced*; D012587:Scimitar Syndrome / Q000150:complications* / Q000601:surgery
D000959:Antihypertensive Agents; D011464:Epoprostenol