title: Inhaled iloprost in patients with chronic thromboembolic pulmonary hypertension: effects before and after pulmonary thromboendarterectomy.
abstract: BACKGROUND
  In primary pulmonary hypertension, aerosolized prostanoids selectively reduce pulmonary vascular resistance and improve right ventricular function. In this study, hemodynamic effects of inhaled iloprost, a stable prostacyclin analogue, were evaluated in patients with chronic thromboembolic pulmonary hypertension (CTEPH) before and early after pulmonary thromboendarterctomy (PTE).
  
  
  METHODS
  Ten patients (mean age 49 years old [32 to 70 years old], New York Heart Association functional class III and IV) received a dose of 33 micro g aerosolized iloprost immediately before surgery (T1), after intensive care unit admission (T2), and 12-hours postoperatively (T3). Effects on pulmonary and systemic hemodynamics and gas exchange were recorded and compared with preinhalation baseline values.
  
  
  RESULTS
  Preoperatively, inhaled iloprost did not significantly change mean pulmonary artery pressure (mPAP), cardiac index (CI), or pulmonary vascular resistance (PVR). Postoperatively, inhaled iloprost induced a significant reduction of mPAP and PVR and a significant increase of CI at T2 and T3. Preinhalation versus postinhalation PVR was as follows: at T1, 847 versus 729 dynes. s. cm(-5), p = 0.45; at T2, 502 versus 316 dynes. s. cm(-5), p = 0.008; and at T3, 299 versus 227 dynes. s. cm(-5), p = 0.004.
  
  
  CONCLUSIONS
  In patients with CTEPH, inhalation of iloprost elicits no significant pulmonary vasodilation before surgery, and may have detrimental effects on systemic hemodynamics. Postoperatively, it significantly reduces mPAP and PVR, and enhances CI. Following PTE, inhalation of iloprost is useful to improve early postoperative hemodynamics.
authors.affiliation: Departments of Cardiothoracic and Vascular Surgery, Mainz, Germany. kramm@mail.uni-mainz.de
authors.forename: Thorsten
authors.initials: T
authors.lastname: Kramm
authors.forename: Balthasar
authors.initials: B
authors.lastname: Eberle
authors.forename: Frank
authors.initials: F
authors.lastname: Krummenauer
authors.forename: Stefan
authors.initials: S
authors.lastname: Guth
authors.forename: Hellmut
authors.initials: H
authors.lastname: Oelert
authors.forename: Eckhard
authors.initials: E
authors.lastname: Mayer
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D004691:Endarterectomy; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000188:drug therapy*; D016285:Iloprost / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011300:Preoperative Care; D011655:Pulmonary Embolism / Q000150:complications* / Q000601:surgery*; D014665:Vasodilator Agents / Q000008:administration & dosage*
chemical_list: D014665:Vasodilator Agents; D016285:Iloprost